INTRODUCTION: Trauma-induced coagulopathy (TIC) is a form of coagulopathy unique to trauma patients and is associated with increased mortality. The complexity and incomplete understanding of TIC have resulted in controversies regarding optimum management. This review aims to summarise the pathophysiology of TIC and appraise established and emerging advances in the management of TIC. METHODS: This narrative review is based on a literature search (MEDLINE database) completed in October 2020. Search terms used were "trauma induced coagulopathy", "coagulopathy of trauma", "trauma induced coagulopathy pathophysiology", "massive transfusion trauma induced coagulopathy", "viscoelastic assay trauma induced coagulopathy", "goal directed trauma induced coagulopathy and "fibrinogen trauma induced coagulopathy'. RESULTS: TIC is not a uniform phenotype but a spectrum ranging from thrombotic to bleeding phenotypes. Evidence for the management of TIC with tranexamic acid, massive transfusion protocols, viscoelastic haemostatic assays (VHAs), and coagulation factor and fibrinogen concentrates were evaluated. Although most trauma centres utilise fixed-ratio massive transfusion protocols, the "ideal" transfusion ratio of blood to blood products is still debated. While more centres are using VHAs to guide blood product replacement, there is no agreed VHA-based transfusion strategy. The use of VHA to quantify the functional contributions of individual components of coagulation may permit targeted treatment of TIC but remains controversial. CONCLUSION A greater understanding of TIC, advances in point-of-care coagulation testing, and availability of coagulation factors and fibrinogen concentrates allows clinicians to employ a more goal-directed approach. Still, hospitals need to tailor their approaches according to available resources, provide training and establish local guidelines.
Blood Coagulation Disorders/therapy* ; Blood Transfusion ; Hemorrhage ; Hemostasis ; Hemostatics ; Humans

In recent years, damage control is well established as a potentially life-saving procedure in a few selected critically injured patients. The "damage control" concept also has been shown to increase overall survival and is likely to modify the management of critically ill patients suffering from gastrointestinal disease. In these patients the "lethal triad" of hypothermia, acidosis, and coagulopathy acts as a vicious cycle that often can not be interrupted and marks the limit of the patient's ability to cope with the physiological consequences of traditional and extensive surgical procedures. The principles of damage control are to control bleeding, obstruction, and/or infection until the physiologic derangement has been restored and the patient could undergo a prolonged operation for definitive repair. This approach is unfolded in three phases. During the initial operation, the surgeon carries out only the absolute minimum necessary to improve patient's condition and to control bleeding, obstruction, and/or infection. The second phase consists of secondary resuscitation in the intensive care unit, characterized by maximization of hemodynamics, correction of coagulopathy, rewarming, and complete ventilatory support. During the third phase, definitive operation is performed.
Acidosis ; therapy ; Blood Coagulation Disorders ; therapy ; Critical Care ; Gastrointestinal Tract ; surgery ; Humans ; Hypothermia ; therapy ; Perioperative Care

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease caused by uncontrolled proliferation of activated macrophage, and secreting high amounts of inflammatory cytokines which lead to multi-organ dysfunction syndrome. HLH patients often show different clinical characteristics during the disease was progressed, in which coagulopathy were the most common, including thrombocytopenia and hypofibrinogenemia, those are the major cause of death in patients, and the clinicians should increase awareness of the mechanisms, clinical characteristics, prognosis and treatment. In this review, the above problems are briefly summarized, to deepen understanding of the HLH related coagulation dysfunctions, and early identification and treatment to reduce mortality, so as to provide more opportunities for HLH patients to recieve subsequent treatment.
Afibrinogenemia ; Blood Coagulation Disorders/therapy* ; Humans ; Lymphohistiocytosis, Hemophagocytic/therapy* ; Prognosis ; Thrombocytopenia

Blood Coagulation Disorders ; therapy ; Fever ; complications ; therapy ; Humans ; Lung Injury ; therapy ; Multiple Organ Failure ; therapy ; Sepsis ; complications ; mortality ; therapy ; Syndrome

Asian Continental Ancestry Group ; Blood Coagulation Disorders/therapy* ; China ; Consensus ; Hemorrhage ; Humans

The Sepsis Coagulopathy Asahi Recombinant LE Thrombomodulin (SCARLET) trial has many defects, and thus cannot be the terminator of recombinant thrombomodulin (rTM). On the contrary, it provides sufficient evidence for further research. Based on analysis focusing on the failure of SCARLET and several previous anticoagulant studies, it is most important for new studies to grasp the following two points: (1) The enrolled cases should have sufficient disease severity and a clear standard for disseminated intravascular coagulation; (2) Heparin should not be used in combination with the investigated drugs. Multiple post-hoc analyses show that no combination of heparin will not increase the risk of thromboembolism. In fact, the combination of heparin can mask the true efficacy of the investigated drug. Due to the complexity of sepsis treatment and the limitations of clinical studies, the results of all treatment studies should be repeatedly verified, rather than be determined at one stroke. Some research conclusions contrary to disease physiology, pharmacology and clinical practice may be deceptive, and should be cautious rather than be simply accepted. On the other hand, the dissenting voices in the "consensus" scene are often well discussed by the authors and should be highly valued.
Humans ; Anticoagulants/therapeutic use* ; Thrombomodulin/therapeutic use* ; Blood Coagulation Disorders ; Disseminated Intravascular Coagulation/drug therapy* ; Sepsis/drug therapy* ; Heparin/therapeutic use* ; Recombinant Proteins

Betacoronavirus ; Blood Coagulation Disorders/therapy* ; COVID-19 ; Coronavirus Infections/complications* ; Humans ; Pandemics ; Pneumonia, Viral/complications* ; SARS-CoV-2

OBJECTIVETo study the effect of catalpol and puerarin freeze-dried powder for injection (CPFPI), a new compound traditional Chinese medicine (TCM) preparation, on coagulability, hemorheology and NO in rats with qi-deficiency and blood-stasis syndrome.

METHODThe model of rats with qi-deficiency and blood-stasis syndrome was established by hunger, fatigue, cold-dampness, panic and high fat diet. Coagulation time (CT) was observed by the glass method, and bleeding time (BT) was measured by tail-cutting method. The effects of CPFPI were also evaluated with prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT). HCT was measured by the electric tesistance method, hemorheology indicators were observed by auto-hemorheological instrument. The level of NO in blood serum was measured by NO assay kit.

RESULTCPFPI 65.40 mg x kg(-1) significantly prolonged CT, BT, PT, APTT and TT in rats. The viscosity of whole blood and plasma, hematocrit, erythrocyte aggregation and rigidity index, and reduced viscosity of whole blood in 65.40 mg x kg(-1) groups were lower than model group. CPFPI 65.40 mg x kg(-1) can raise the level of NO in blood serum. 32.70 mg x kg(-1) markedly prolonged CT, PT and APTT and decreased whole blood viscosity, erythrocyte aggregation index and whole blood reduction viscosity.

CONCLUSIONCPFPI has a significant effect in improving coagulability and hemorheology index and enhancing NO content in blood serum.

Animals ; Blood Coagulation ; drug effects ; Blood Coagulation Disorders ; blood ; drug therapy ; Blood Viscosity ; drug effects ; Freeze Drying ; Iridoid Glucosides ; pharmacology ; Isoflavones ; pharmacology ; Male ; Medicine, Chinese Traditional ; Nitric Oxide ; blood ; Powders ; Qi ; Rats ; Rats, Sprague-Dawley

Blood Coagulation Disorders ; drug therapy ; Child ; Child, Preschool ; Drug Therapy, Combination ; Female ; Heparin ; administration & dosage ; Humans ; Male ; Nephrotic Syndrome ; blood ; complications ; urine ; Urokinase-Type Plasminogen Activator ; administration & dosage

Trauma is a major cause of death, and haemorrhage represents an important target for improving outcomes after severe injury. Volume replacement with crystalloids in resuscitation might become harmful in large amounts because of coagulopathy. A fine balance must be achieved between haemodynamic and haemostatic resuscitation. Permissive hypotension refers to permitting some degree of hypotension in such adult patients in an attempt to attain this fine balance. For patients who require a significant volume of blood product resuscitation, the term 'massive transfusion protocol' (MTP) is used. There is very little data on transfusion protocols for paediatric trauma patients, and children respond to hypovolemic shock in a different physiological manner compared to adults. Hence, concepts such as permissive hypotension may not be appropriate when treating children involved in major trauma. We recently embarked on a plan to streamline the management of blood transfusion in massive bleeding during paediatric trauma, to reduce the logistical problems associated with the transport of blood products from the blood bank to the patient. From this, we evolved a MTP for paediatric major trauma. Nonetheless, further studies will be needed to see if there is indeed improved outcome after MTP in paediatric major trauma as current evidence is extrapolated from adult studies.
Adult ; Blood Coagulation Disorders ; complications ; therapy ; Child ; Clinical Protocols ; Evidence-Based Medicine ; Fluid Therapy ; standards ; Humans ; Injury Severity Score ; Resuscitation ; methods ; Wounds and Injuries ; complications ; therapy