Trauma‐induced coagulopathy: The past, present, and future
Author(s): ,
Lucy Z. Kornblith
Affiliations:
Department of Surgery, Zuckerberg San Francisco General Hospital, University of California, San Francisco, California
Correspondence |Lucy Z. Kornblith, Department of Surgery, Zuckerberg San Francisco General Hospital and the University of California, 1001 Potrero Avenue, Building 1, Suite 210, San Francisco, CA 94110.|Email: lucy.kornblith@ucsf.edu
,
Hunter B. Moore
Affiliations:
Department of Surgery, Denver Health Medical Center, University of Colorado, Denver
Mitchell J. Cohen
Affiliations:
Department of Surgery, Denver Health Medical Center, University of Colorado, Denver
ISTH Academy. Z. Kornblith . May 31, 2019; 273617
Correspondence |Lucy Z. Kornblith

Correspondence
|Lucy  Z. Kornblith
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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.
Keyword(s)
blood coagulation disorders, exsanguination, hemorrhagic shock, hemostasis, trauma
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