Anest. intenziv. Med. 2023;34(4):157-164 | DOI: 10.36290/aim.2023.050
Trauma-induced coagulopathy - pathophysiology, diagnostics and treatmentReview Article
- 1 Anesteziologicko‑resuscitační oddělení, Fakultní nemocnice Bulovka, Praha
- 2 Oddělení urgentního příjmu, Fakultní nemocnice Bulovka, Praha
- 3 Katedra biomedicínské techniky, Fakulta biomedicínského inženýrství, České vysoké učení technické v Praze, Kladno
- 4 Univerzita Karlova, Lékařská fakulta v Hradci Králové, Hradec Králové
- 5 Klinika anesteziologie, resuscitace a intenzivní medicíny, Univerzita Karlova, Lékařská fakulta v Hradci Králové, Fakultní nemocnice Hradec Králové, Hradec Králové
- 6 Klinika anesteziologie a resuscitace, Fakultní nemocnice Královské Vinohrady, Univerzita Karlova, 3. lékařská fakulta, Praha
- 7 Dept. of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- 8 Technická univerzita v Liberci
This narrative review article summarizes the contemporary view on the basic principles of pathophysiology, diagnosis and treatment of trauma-induced coagulopathy in patients with severe trauma.
Keywords: trauma, coagulopathy, fibrinogen.
Received: September 19, 2023; Revised: October 23, 2023; Accepted: October 25, 2023; Prepublished online: November 14, 2023; Published: December 15, 2023 Show citation
References
- Eurostat data browser. Causes of death - deaths by country of residence and occurrence. Https://EcEuropaEu/Eurostat/Databrowser/View/HLTH_CD_ARO__custom_6117957/Default/Table?Lang=en & page=time:2019. 2023.
- Tien HC, Spencer F, Tremblay LN, Rizoli SB, Brenneman FD. Preventable deaths from hemorrhage at a Level I Canadian trauma center. Journal of Trauma - Injury, Infection and Critical Care. 2007;62(1):142-146. DOI: 10.1097/01.ta.0000251558.38388. 47.
Go to original source...
- Sauaia A, Moore F. Epidemiology of Trauma Deaths: A Reassessment. Journal of Trauma and Acute Care Surgery. 1995;38(2):185-193.
Go to original source...
Go to PubMed...
- Moore EE, Moore HB, Kornblith LZ, Neal MD, Hoffman M, Mutch NJ, et al. Trauma‑induced coagulopathy. Nature Reviews Disease Primers. 2021;7(1). DOI: 10.1038/s41572-021-00264-3.
Go to original source...
Go to PubMed...
- Cohen MJ, Kutcher M, Redick B, Nelson M, Call M, Knudson MM, et al; PROMMTT Study Group. Clinical and mechanistic drivers of acute traumatic coagulopathy. J Trauma Acute Care Surg. 2013 Jul;75(1 Suppl 1):S40-7. doi: 10.1097/TA.0b013e31828fa43d. PMID: 23778510; PMCID: PMC3755603.
Go to original source...
Go to PubMed...
- Rossaint R, Afshari A, Bouillon B, Cerny V, Cimpoesu D, Curry N, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Critical Care. 2023;27(1). DOI: 10.1186/s13054-023-04327-7.
Go to original source...
Go to PubMed...
- Hoffman M, Monroe D. A Cell‑based Model of Hemostasis. Thrombosis and Haemostasis. 2001;85(06):958-965. DOI: 10.1055/s-0037-1615947.
Go to original source...
- Fort AC, Dudaryk R. Evolving science of trauma‑induced coagulopathy. International Anesthesiology Clinics. 2021;59(2):25-30. DOI: 10.1097/AIA.0000000000000318.
Go to original source...
Go to PubMed...
- Moore HB, Moore EE. Temporal Changes in Fibrinolysis following Injury. Seminars in Thrombosis and Hemostasis. 2020;46(2):189-198. DOI: 10.1055/s-0039-1701016.
Go to original source...
Go to PubMed...
- Moore HB, Moore EE, Gonzalez E, Huebner BJ, Sheppard F, Banerjee A, et al. Reperfusion Shutdown: Delayed Onset of Fibrinolysis Resistance after Resuscitation from Hemorrhagic Shock Is Associated with Increased Circulating Levels of Plasminogen Activator Inhibitor-1 and Postinjury Complications. Blood. 2016;128(22):206. DOI: 10.1182/BLOOD.V128. 22. 206.206.
Go to original source...
- Moore HB, Moore EE, Gonzalez E, Chapman MP, Chin TL, Silliman CC, et al. Hyperfibrinolysis, physiologic fibrinolysis, and fibrinolysis shutdown: the spectrum of postinjury fibrinolysis and relevance to antifibrinolytic therapy. J Trauma Acute Care Surg. 2014 Dec;77(6):811-7; discussion 817. doi: 10.1097/TA.0000000000000341. PMID: 25051384; PMCID: PMC4370273.
Go to original source...
Go to PubMed...
- Cap A, Hunt BJ. The pathogenesis of traumatic coagulopathy. Anaesthesia. 2015;70(s1):96-e34. DOI: 10.1111/ANAE.12914.
Go to original source...
Go to PubMed...
- Mitrophanov AY, Vandyck K, Tanaka KA. Thrombin Generation in Trauma Patients: How Do we Navigate Through Scylla and Charybdis? Current Anesthesiology Reports. 2022;12(2):308-319. DOI: 10.1007/s40140-021-00502-0.
Go to original source...
- Vulliamy P, Kornblith LZ, Kutcher ME, Cohen MJ, Brohi K, Neal MD. Alterations in platelet behavior after major trauma: adaptive or maladaptive? Platelets. 2021;32(3):295-304. DOI: 10.1080/09537104.2020.1718633.
Go to original source...
Go to PubMed...
- Maegele M, Schöchl H, Menovsky T, Maréchal H, Marklund N, Buki A, et al. Coagulopathy and haemorrhagic progression in traumatic brain injury: advances in mechanisms, diagnosis, and management. The Lancet Neurology. 2017;16(8):630-647. DOI: 10.1016/S1474-4422(17)30197-7.
Go to original source...
Go to PubMed...
- Johansson PI, Stensballe J, Ostrowski SR. Shock induced endotheliopathy (SHINE) in acute critical illness - a unifying pathophysiologic mechanism. Critical Care. 2017;21(1). DOI: 10.1186/s13054-017-1605-5.
Go to original source...
Go to PubMed...
- Dobson GP, Morris JL, Letson HL. Why are bleeding trauma patients still dying? Towards a systems hypothesis of trauma. Frontiers in Physiology. 2022;13. DOI: 10.3389/fphys.2022.990903.
Go to original source...
Go to PubMed...
- Cohen MJ, Call M, Nelson M, Calfee CS, Esmon CT, Brohi K, et al. Critical role of activated protein C in early coagulopathy and later organ failure, infection and death in trauma patients. Annals of Surgery. 2012;255(2):379-385. DOI: 10.1097/SLA.0b013e318235d9e6.
Go to original source...
Go to PubMed...
- Zanza C, Romenskaya T, Racca F, Rocca E, Piccolella F, Piccioni A, et al. Severe Trauma‑Induced Coagulopathy: Molecular Mechanisms Underlying Critical Illness. International Journal of Molecular Sciences. 2023;24(8). DOI: 10.3390/ijms24087118.
Go to original source...
Go to PubMed...
- Cohen MJ, Brohi K, Ganter MT, Manley GT, Mackersie RC, Pittet JF. Early coagulopathy after traumatic brain injury: the role of hypoperfusion and the protein c pathway. Journal of Trauma. 2007;63(6):1254-1262. DOI: 10.1097/TA.0B013E318156EE4C.
Go to original source...
Go to PubMed...
- Monroe DM, Hoffman M, Wolberg AS, Meng H, Monroe Iii DM. A Systematic Evaluation of the Effect of Temperature on Coagulation Enzyme Activity and Platelet Function. The Journal of Trauma and Acute Care Surgery. 2004;56(6):1221-1228. DOI: 10.1097/01.TA.0000064328.97941.FC.
Go to original source...
Go to PubMed...
- Meng ZH, Wolberg AS, Monroe DM, Hoffman M. The effect of temperature and ph on the activity of factor viia: Implications for the efficacy of high‑dose factor viia in hypothermic and acidotic patients. Journal of Trauma. 2003;55(5):886-891. DOI: 10.1097/01.TA.0000066184.20808.A5.
Go to original source...
Go to PubMed...
- DeBot M, Sauaia A, Schaid T, Moore EE. Trauma‑induced hypocalcemia. Transfusion. 2022;62(S1):S274-S280. DOI: 10.1111/trf.16959.
Go to original source...
Go to PubMed...
- Chambers LA, Chow SJ, Shaffer LET. Frequency and characteristics of coagulopathy in trauma patients treated with a low- or high‑plasma‑content massive transfusion protocol. American Journal of Clinical Pathology. 2011;136(3):364-370. DOI: 10.1309/AJCPH16YXJEFSHEO.
Go to original source...
Go to PubMed...
- Chang R, Cardenas JC, Wade CE, Holcomb JB. Advances in the understanding of trauma‑induced coagulopathy. Blood. 2016;128(8):1043-1049. DOI: 10.1182/blood-2016-01-636423.
Go to original source...
Go to PubMed...
- Collis RE, Collins PW. Haemostatic management of obstetric haemorrhage. Anaesthesia. 2015;70(S1). DOI: 10.1111/ANAE.12913.
Go to original source...
Go to PubMed...
- Shah A, Kerner V, Stanworth SJ, Agarwal S. Major haemorrhage: past, present and future. Anaesthesia. 2023;78(1):93-104. DOI: 10.1111/anae.15866.
Go to original source...
Go to PubMed...
- Brohi K, Singh J, Heron M, Coats T. Acute Traumatic Coagulopathy. Journal of Trauma. 2003;54(6):1127-1130. DOI: 10.1097/01.TA.0000069184.82147. 06.
Go to original source...
- Baksaas‑Aasen K, Gall LS, Stensballe J, Juffermans NP, Curry N, Maegele M, et al. Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial. Intensive Care Medicine. 2021;47(1):49-59. DOI: 10.1007/s00134-020-06266-1.
Go to original source...
Go to PubMed...
- David JS, James A, Orion M, Selves A, Bonnet M, Glasman P, et al. Thromboelastometry‑guided haemostatic resuscitation in severely injured patients: a propensity score‑matched study. Critical Care. 2023;27(1). DOI: 10.1186/s13054-023-04421-w.
Go to original source...
Go to PubMed...
- Zatloukal J, Horáková M, Bultasová L, Pouska J, Kletečka J, Beneš J. Point of care examination of blood clotting - current possibilities. Anesteziologie a Intenzivní Medicína. 2021;32(1):14-24. DOI: 10.36290/aim.2020.049.
Go to original source...
- Song JG, Jeong SM, Jun IG, Lee HM, Hwang GS. Five‑minute parameter of thromboelastometry is sufficient to detect thrombocytopenia and hypofibrinogenaemia in patients undergoing liver transplantation. British Journal of Anaesthesia. 2014;112(2):290-297. DOI: 10.1093/bja/aet325.
Go to original source...
Go to PubMed...
- Meyer ASP, Meyer MAS, Sørensen AM, Rasmussen LS, Hansen MB, Holcomb JB, et al. Thrombelastography and rotational thromboelastometry early amplitudes in 182 trauma patients with clinical suspicion of severe injury. Journal of Trauma and Acute Care Surgery. 2014;76(3):682-690. DOI: 10.1097/TA.0000000000000134.
Go to original source...
Go to PubMed...
- Škola J, Bílská M, Horáková M, Tégl V, Beneš J, Škulec R, et al. Shock Index for Early Detection of Low Plasma Fibrinogen in Trauma: A Prospective Observational Cohort Pilot Study. Journal of Clinical Medicine. 2023;12(4). DOI: 10.3390/jcm12041707.
Go to original source...
Go to PubMed...
- David JS, Voiglio EJ, Cesareo E, Vassal O, Decullier E, Gueugniaud PY, et al. Prehospital parameters can help to predict coagulopathy and massive transfusion in trauma patients. Vox Sanguinis. 2017;112(6):557-566. DOI: 10.1111/vox.12545.
Go to original source...
Go to PubMed...
- Gauss T, Campion S, Kerever S, Eurin M, Raux M, Harrois A, et al. Fibrinogen on Admission in Trauma score. European Journal of Anaesthesiology. 2018;35(1):25-32. DOI: 10.1097/EJA.0000000000000734.
Go to original source...
Go to PubMed...
- Gonzalez E, Moore HB, Moore EE, editors. Trauma Induced Coagulopathy. Cham: Springer International Publishing; 2016. DOI: 10.1007/978-3-319-28308-1.
Go to original source...
- Kelly J, Rudd A, Lewis RR, Hunt BJ. Plasma D‑Dimers in the Diagnosis of Venous Thromboembolism. Archives of Internal Medicine. 2002;162(7):747. DOI: 10.1001/archinte.162. 7. 747.
Go to original source...
- Tanswell P, Nieuwenhuizen W, Seifried E. Pharmacokinetics of degradation products of fibrin and fibrinogen during alteplase therapy of acute myocardial infarction. Fibrinolysis. 1993;7(6):408-415. DOI: 10.1016/0268-9499(93)90067-6.
Go to original source...
- Chapman MP, Moore EE, Ramos CR, Ghasabyan A, Harr JN, Chin TL, et al. Fibrinolysis greater than 3% is the critical value for initiation of antifibrinolytic therapy. J Trauma Acute Care Surg. 2013 Dec;75(6):961-7; discussion 967. doi: 10.1097/TA.0b013e3182aa9c9f. PMID: 24256667; PMCID: PMC4072127.
Go to original source...
Go to PubMed...
- Theusinger OM, Wanner GA, Emmert MY, Billeter A, Eismon J, Seifert B, et al. Hyperfibrinolysis diagnosed by rotational thromboelastometry (ROTEM®) Is associated with higher mortality in patients with severe trauma. Anesthesia and Analgesia. 2011;113(5):1003-1012. DOI: 10.1213/ANE.0b013e31822e183f.
Go to original source...
Go to PubMed...
- Gonzalez E, Moore EE, Moore HB. Management of Trauma‑Induced Coagulopathy with Thrombelastography. Critical Care Clinics. 2017;33(1):119-134. DOI: 10.1016/j.ccc.2016. 09. 002.
Go to original source...
- Ranucci M, Baryshnikova E. Sensitivity of viscoelastic tests to platelet function. Journal of Clinical Medicine. 2020;9(1). DOI: 10.3390/jcm9010189.
Go to original source...
Go to PubMed...
- Gosselin R, Grant RP, Adcock DM. Comparison of the effect of the anti‑Xa direct oral anticoagulants apixaban, edoxaban, and rivaroxaban on coagulation assays. International Journal of Laboratory Hematology. 2016;38(5):505-513. DOI: 10.1111/ijlh.12528.
Go to original source...
Go to PubMed...
- Seyve L, Richarme C, Polack B, Marlu R. Impact of four direct oral anticoagulants on rotational thromboelastometry (ROTEM). International Journal of Laboratory Hematology. 2018;40(1):84-93. DOI: 10.1111/ijlh.12744.
Go to original source...
Go to PubMed...
- Smith RM, Conn AK. Prehospital care - Scoop and run or stay and play? Injury. 2009;40(SUPPL. 4). DOI: 10.1016/j.injury.2009. 10. 033.
Go to original source...
- Crash-2 trial collaborators. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo‑controlled trial. The Lancet. 2010;376(9734):23-32. DOI: 10.1016/S0140-6736(10)60835-5.
Go to original source...
Go to PubMed...
- Hmidan Simsam M, Delorme L, Grimm D, Priestap F, Bohnert S, Descoteaux M, et al. Efficacy of high dose tranexamic acid (TXA) for hemorrhage: A systematic review and meta‑analysis. Injury. 2023;54(3):857-870. DOI: 10.1016/j.injury.2022. 12. 029.
Go to original source...
- Barelli S, Alberio L. The role of plasma transfusion in massive bleeding: Protecting the endothelial glycocalyx? Frontiers in Medicine. 2018;5(APR). DOI: 10.3389/fmed.2018.00091.
Go to original source...
Go to PubMed...
- Adam EH, Fischer D. Plasma Transfusion Practice in Adult Surgical Patients: Systematic Review of the Literature. Transfusion Medicine and Hemotherapy. 2020;47(5):347-359. DOI: 10.1159/000511271.
Go to original source...
Go to PubMed...
- Innerhofer P, Fries D, Mittermayr M, Innerhofer N, von Langen D, Hell T, et al. Reversal of trauma‑induced coagulopathy using first‑line coagulation factor concentrates or fresh frozen plasma (RETIC): A single‑centre, parallel‑group, open‑label, randomised trial. The Lancet Haematology. 2017;4(6):e258-e271. DOI: 10.1016/S2352-3026(17)30077-7.
Go to original source...
Go to PubMed...
- Allen CJ, Shariatmadar S, Meizoso JP, Hanna MM, Mora JL, Ray JJ, et al. Liquid plasma use during "super" massive transfusion protocol. Journal of Surgical Research. 2015;199(2):622-628. DOI: 10.1016/j.jss.2015. 06. 022.
Go to original source...
- Kyle T, Greaves I, Beynon A, Whittaker V, Brewer M, Smith J. Ionised calcium levels in major trauma patients who received blood en route to a military medical treatment facility. Emergency Medicine Journal. 2018;35(3):176-179. DOI: 10.1136/emermed-2017-206717.
Go to original source...
Go to PubMed...
- Kleber C, Sablotzki A, Casu S, Olivieri M, Thoms KM, Horter J, et al. The impact of acquired coagulation factor XIII deficiency in traumatic bleeding and wound healing. Critical Care. 2022;26(1). DOI: 10.1186/s13054-022-03940-2.
Go to original source...
Go to PubMed...
- Lawless RA, Holcomb JB. Plasma Trasfusion. In: Gonzalez E, Moore HB, Moore EE, editors. Trauma Induced Coagulopathy, Cham: Springer International Publishing; 2016. DOI: 10.1007/978-3-319-28308-1.
Go to original source...
- Kietaibl S, Ahmed A, Afshari A, Albaladejo P, Aldecoa C, Barauskas G, et al. Management of severe peri‑operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care: Second update 2022. European Journal of Anaesthesiology. 2023;40(4):226-304. DOI: 10.1097/EJA.0000000000001803.
Go to original source...
Go to PubMed...
- Hornor MA, Duane TM, Ehlers AP, Jensen EH, Brown PS, Pohl D, et al. American College of Surgeons' Guidelines for the Perioperative Management of Antithrombotic Medication. Journal of the American College of Surgeons. 2018;227(5):521-536.e1. DOI: 10.1016/j.jamcollsurg.2018. 08. 183.
Go to original source...