Trauma remains a leading cause of death and disability in adults in spite of advances in resuscitation, surgical management, and critical care . Between 25 to 35 percent of injured civilian trauma patients develop a biochemically evident coagulopathy upon arrival in the emergency department, in spite of improved efficiency of trauma systems, military and civilian, in reducing the time interval between acute injury and treatment [2-4]. Coagulopathy may be the result of physiologic derangements such as acidosis, hypothermia, or hemodilution related to fluid or blood administration; however, an acute coagulopathy can also occur in severely injured patients independent of, or in addition to, these factors [2,3]. Several terms are used in the literature to refer to this condition, including acute traumatic coagulopathy (ATC), early coagulopathy of trauma (ECT), trauma-induced coagulopathy, and the acute coagulopathy of trauma-shock (ACoTS) [2,3,5,6].
The etiology, diagnosis and treatment of coagulopathy associated with trauma will be reviewed here. The general principles of shock management in the trauma patient and the treatment of excessive anticoagulation related to medical treatment are discussed elsewhere. (See "Correcting excess anticoagulation after warfarin" and "Initial evaluation and management of shock in adult trauma".)
Coagulopathy in trauma patients, and specifically acute traumatic coagulopathy (ATC), is associated with higher transfusion requirements, longer intensive care unit and hospital stays, more days requiring mechanical ventilation, and a greater incidence of multiorgan dysfunction. Compared with patients who do not have coagulopathy, those with coagulopathy have a threefold to fourfold greater mortality, and are up to eight times more likely to die within the first 24 hours following injury [2-4,7,8].
Injury to brain tissue may predispose to acute traumatic coagulopathy and about one-third of patients with traumatic brain injury (TBI) have a coagulopathy.
The etiology of coagulopathy in the injured patient is multifactorial with overlapping contributions depending upon the injury and nature of resuscitation. Normal coagulation is a balance between hemostatic and fibrinolytic processes which permit control of bleeding following mild injury while preventing inappropriate intravascular thrombosis. (See "Overview of hemostasis".)