Treatment of Acute Coagulopathy Associated with Trauma

Coagulopathy is frequently present in trauma. It is indicative of the severity of trauma and contributes to increased morbidity and mortality. Uncontrolled bleeding is the most frequent preventable cause of death in trauma patients reaching hospital alive. Coagulopathy in trauma has been long thought to develop as a result of hemodilution, acidosis, and hypothermia often related to resuscitation practices. However, altered coagulation tests are already present in 25–30% of severe trauma patients upon hospital arrival before resuscitation efforts. Acute coagulopathy associated with trauma (ACoT) has been recognized in recent years as a distinct entity associated with increased mortality, morbidity, and transfusion requirements. Transfusion and nontransfusion strategies aimed at correcting ACoT, particularly in patients with massive bleeding and massive transfusion, are currently available. Early administration of tranexamic acid to bleeding trauma patients safely reduces the risk of death. It has been proposed that early aggressive blood product transfusional management of ACoT with a red blood cell？:？plasma？:？platelets ratio close to 1？:？1？:？1 could result in decreased mortality from uncontrolled bleeding. 1. Introduction Trauma is the main cause of death in people under 40 years and contributes to 10% of deaths worldwide. Up to 40% of trauma deaths are secondary to uncontrolled bleeding, constituting the leading cause of trauma hospital mortality (within the first 48 hours of evolution) and therefore a preventable cause of death [1]. It is recognized that coagulopathy can be present in the early stages of trauma, with altered coagulation tests being found in up to 30% of cases at the time of hospital admission [2]. Thus, acute coagulopathy associated with trauma (ACoT) seems to be a manifestation of the severity of the injuries sustained and the degree of shock. It is associated with higher mortality and greater transfusion requirements [3, 4]. Currently, both transfusion and nontransfusion strategies exist, which are aimed at correcting ACoT, particularly in patients with massive bleeding and massive transfusion (MT) and may result in a decrease in mortality from uncontrolled bleeding. This paper will review ACoT, with particular emphasis on its treatment. 2. Acute Coagulopathy Associated with Trauma Coagulopathy is a common phenomenon in traumatized patients as well as a marker of injury severity. Abnormal coagulation favors continuous loss of blood, increasing the risk of morbidity and death from uncontrolled bleeding. Coagulopathy in trauma has