Trauma-induced coagulopathy: The past, present, and future

Abstract

Trauma remains a leading cause of death worldwide, and most early preventable deaths in both the civilian and military settings are due to uncontrolled hemorrhage, despite paradigm advances in modern trauma care. Combined tissue injury and shock result in hemostatic failure, which has been identified as a multidimensional molecular, physiologic and clinical disorder termed trauma-induced coagulopathy (TIC). Understanding the biology of TIC is of utmost importance, as it is often responsible for uncontrolled bleeding, organ failure, thromboembolic complications, and death. Investigations have shown that TIC is characterized by multiple phenotypes of impaired hemostasis due to altered biology in clot formation and breakdown. These coagulopathies are attributable to tissue injury and shock, and encompass underlying endothelial, immune and inflammatory perturbations. Despite the recognition and identification of multiple mechanisms and mediators of TIC, and the development of targeted treatments, the mortality rates and associated morbidities due to hemorrhage after injury remain high. The purpose of this review is to examine the past and present understanding of the multiple distinct but highly integrated pathways implicated in TIC, in order to highlight the current knowledge gaps and future needs in this evolving field, with the aim of reducing morbidity and mortality after injury.

Keywords: blood coagulation disorders; exsanguination; hemorrhagic shock; hemostasis; trauma.

Conflict of interest statement

Authorship Details

L.Z. Kornblith., H.B. Moore, and M.J. Cohen contributed equally to this review. This manuscript is original work, not previously published and is not under consideration of publication elsewhere. The manuscript has been read and approved for submission to JTH by all qualified authors. Dr. Moore reports is a Co-Founder and Board Member with Thrombo Therapuetics Incorporated and Served on the Advisory Committee for Instrument Laboratories. Dr. Cohen and Dr. Kornblith have no actual or potential conflict of interest capable of influencing their judgment.

© 2019 International Society on Thrombosis and Haemostasis.