Acute Coagulopathy of Trauma
This page is due for revision.
OVERVIEW
- new terms that are in vogue are trauma-induced coagulopathy (TIC) and acute traumatic coagulopathy (ATC)
- not simply a ‘dilutional coagulopathy’ or ‘consumptive coagulopathy’!
PATHOPHYSIOLOGY
- TIC was conventionally construed simply as depletion, dysfunction or dilution of procoagulant factors
- actually an imbalance of the dynamic equilibrium between procoagulant factors, anticoagulant factors, platelets, endothelium and fibrinolysis
- characterized by isolated factor V inhibition, dysfibrinogenemia, systemic anticoagulation, impaired platelet function and hyperfibrinolysis
- exacerbated by hypothermia, acidosis (together with coagulopathy they form ‘the lethal triad’) and resuscitation with hypocoagulable fluids
MANAGEMENT
- early detection (ROTEM /TEG holds promise for this)
- early activation of massive transfusion protocols
- aggressive proactive blood product administration (PRBCs, FFP, platelets, cryoprecipitate)
- prevent and treat hypothermia and acidosis
- early use of tranexamic acid
- give calcium if hypocalcaemic
- consider Factor VII if non-surgical bleeding and all the other parameters have been corrected
References and links
CCC Transfusion Series
Blood Products: Cryoprecipitate, Fresh Frozen Plasma (FFP), Platelets, Red Cells (RBCs)
>>> Factor Concentrates: Prothrombinex, Factor VIIa, Fibrinogen Concentrate
Reversal Agents:
>>> Rivaroxaban / Apixaban / Enoxaparin: Andexanet Alfa, Rivaroxaban and Bleeding
>>> Dabigatran: Idarucuzimab, Dabigatran and bleeding
>>> Heparin: Protamine
>>> Warfarin: Vitamin K, FFP, PTx, Warfarin Refersal, Warfarin Toxicity
Testing: Coagulation Studies, TEG / ROTEM (Thromboelastography), Platelet function assays
Conditions: Acute Coagulopathy of Trauma, Disseminated Intravascular Coagulation (DIC), Massive Blood Loss
General Topics: Blood Bank, Blood Conservation Strategies, Blood Product Compatibilities, Blood Transfusion Risks, Massive Transfusion Protocol (MTP), Modifications to Blood Components, Procedures and Coagulopathy, Storage Lesions, TRALI, Transfusion Literature, Transfusion Reactions
References
- Frith D, Brohi K. The pathophysiology of trauma-induced coagulopathy. Curr Opin Crit Care. 2012 Dec;18(6):631-6. PMID: 23010636.
- Frith D, Davenport R, Brohi K. Acute traumatic coagulopathy. Curr Opin Anaesthesiol. 2012 Apr;25(2):229-34. PMID: 22270921.
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Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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