Coagulation dysfunction after major war trauma is conventionally attributed to consumption and dilution of coagulation factors. However, recent studies have identified an acute coagulation dysfunction at the early stage after trauma. This coagulation dysfunction due to endogenous coagulation disturbance at the early stage after trauma is called acute traumatic coagulation dysfunction (ATCD), and the patients with ATCD would have an increased complication rate and mortality. Standard coagulation tests provide only limited information on the underlying coagulation disorder. Viscoelastic haemostatic assays (VHA) such as rotational thromboelastometry or thrombelastography offer a more comprehensive insight into the coagulation process. Early goal-directed coagulation therapy guided by VHA could change administration of blood products and improve diagnosis of trauma patients.