Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 3/2014

Open Access 01-06-2014 | Commentary

Coagulopathy following major trauma hemorrhage: lytic, lethal and a lack of fibrinogen

Author: Ross Davenport

Published in: Critical Care | Issue 3/2014

Login to get access

Abstract

Trauma-induced coagulopathy (TIC) is present soon after injury and is associated with increased transfusion requirements and worse outcomes. The pathophysiological mechanisms, which result in the widespread derangements of hemostasis following major trauma hemorrhage, are as yet not fully defined. Profound activation of fibrinolytic pathways and fibrinogen depletion appear to be fundamental processes in the development of TIC and offer potential therapeutic targets. Collaborative and multi-disciplinary scientific study is thus a research priority in order to characterize the primary drivers of TIC and develop targeted and efficacious treatment strategies.
Literature
1.
Oshiro A, Yanagida Y, Gando S, Henzan N, Takahashi I, Makise H: Hemostasis during the early stages of trauma: comparison with disseminated intravascular coagulation. Crit Care 2014, 18: R61. 10.1186/cc13816PubMedPubMedCentralCrossRef
2.
Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H, Gogichaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA, Mejía-Mantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Ravi RR, Yutthakasemsunt S, CRASH-2 trial collaborators: Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010, 376: 23.PubMedCrossRef
3.
Brohi K, Cohen MJ, Ganter MT, Matthay MA, Mackersie RC, Pittet JF: Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway? Ann Surg 2007, 245: 812-818. 10.1097/01.sla.0000256862.79374.31PubMedPubMedCentralCrossRef
4.
5.
6.
Hauser CJ, Boffard K, Dutton R, Bernard GR, Croce MA, Holcomb JB, Leppaniemi A, Parr M, Vincent JL, Tortella BJ, Dimsits J, Bouillon B, CONTROL Study Group: Results of the CONTROL trial: efficacy and safety of recombinant activated Factor VII in the management of refractory traumatic hemorrhage. J Trauma 2010, 69: 489-500. 10.1097/TA.0b013e3181edf36ePubMedCrossRef
7.
8.
Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Filipescu D, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Vincent JL, Rossaint R: Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care 2013, 17: R76. 10.1186/cc12685PubMedPubMedCentralCrossRef
9.
Inaba K, Karamanos E, Lustenberger T, Schochl H, Shulman I, Nelson J, Rhee P, Talving P, Lam L, Demetriades D: Impact of fibrinogen levels on outcomes after acute injury in patients requiring a massive transfusion. J Am Coll Surg 2013, 216: 290-297. 10.1016/j.jamcollsurg.2012.10.017PubMedCrossRef
10.
Rourke C, Curry N, Khan S, Taylor R, Raza I, Davenport R, Stanworth S, Brohi K: Fibrinogen levels during trauma hemorrhage, response to replacement therapy, and association with patient outcomes. J Thromb Haemost 2012, 10: 1342-1351. 10.1111/j.1538-7836.2012.04752.xPubMedCrossRef
11.
12.
13.
Raza I, Davenport R, Rourke C, Platton S, Manson J, Spoors C, Khan S, De’Ath HD, Allard S, Hart DP, Pasi KJ, Hunt BJ, Stanworth S, MacCallum PK, Brohi K: The incidence and magnitude of fibrinolytic activation in trauma patients. J Thromb Haemost 2013, 11: 307-314. 10.1111/jth.12078PubMedCrossRef
14.
Schochl H, Frietsch T, Pavelka M, Jambor C: Hyperfibrinolysis after major trauma: differential diagnosis of lysis patterns and prognostic value of thrombelastometry. J Trauma 2009, 67: 125-131. 10.1097/TA.0b013e31818b2483PubMedCrossRef
15.
Khan S, Brohi K, Chana M, Raza I, Stanworth S, Gaarder C, Davenport R, International Trauma Research Network (INTRN): Hemostatic resuscitation is neither hemostatic nor resuscitative in trauma hemorrhage. J Trauma Acute Care Surg 2014, 76: 561-568. 10.1097/TA.0000000000000146PubMedCrossRef
Metadata
Title
Coagulopathy following major trauma hemorrhage: lytic, lethal and a lack of fibrinogen
Author
Ross Davenport
Publication date
01-06-2014
Publisher
BioMed Central
Published in
Critical Care / Issue 3/2014
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc13923

Other articles of this Issue 3/2014

Critical Care 3/2014 Go to the issue

Journal club critique

‘To prone or not to prone’ in severe ARDS: questions answered, but others remain

Letter

Plasma antioxidant capacity in critical polytraumatized patients?: methods, severity, and anatomic location

Research

β-lactam antibiotic concentrations during continuous renal replacement therapy

Research

Long-term outcome of delirium during intensive care unit stay in survivors of critical illness: a prospective cohort study

Research

Continuous versus bolus intermittent loop diuretic infusion in acutely decompensated heart failure: a prospective randomized trial

Research

Timing of vasopressor initiation and mortality in septic shock: a cohort study