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Trauma-Induced Coagulopathy: Diagnosis and Management in 2020

  • Blood Management (KA Tanaka, Section Editor)
  • Published:
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Abstract

Purpose of Review

This review describes the mechanisms underlying trauma-induced coagulopathy (TIC) and the current strategies to measure and mitigate the negative effects of TIC during the initial stages of trauma resuscitation and care.

Recent Findings

Trauma patients can manifest both early hypocoagulable and later hypercoagulable phenotypes. These are not fixed states and patient transition between states postinjury. Recent trends in resuscitation, driven by the military experience, have promoted the return to whole blood as the initial resuscitative fluid in the severely injured patient, but goal-directed blood product administration remains critically important to restore coagulation homeostasis and avoid microvascular thrombotic events.

Summary

As our understanding of TIC improves, we anticipate that whole blood resuscitation will replace empiric ratios for the severely injured patient with uncontrolled cavitary bleeding with a transition to goal-directed resuscitation and de-escalation of blood product administration once mechanical hemostasis is achieved.

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References

  1. National Center for Injury Prevention and Control CDC. 10 leading causes of death by age group, United States - 2017. Available from: https://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_by_age_group_2017_1100w850h.jpg.

  2. Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, et al. Epidemiology of trauma deaths: a reassessment. J Trauma. 1995;38(2):185–93.

    Article  CAS  PubMed  Google Scholar 

  3. Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003;54(6):1127–30.

    Article  PubMed  Google Scholar 

  4. MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma. 2003;55(1):39–44.

    Article  PubMed  Google Scholar 

  5. Sumislawski JJ, Christie SA, Kornblith LZ, Stettler GR, Nunns GR, Moore HB, et al. Discrepancies between conventional and viscoelastic assays in identifying trauma-induced coagulopathy. Am J Surg. 2019;217(6):1037–41.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Davie EW, Ratnoff OD. Waterfall sequence for intrinsic blood clotting. Science. 1964;145(3638):1310–2.

    Article  CAS  PubMed  Google Scholar 

  7. Hoffman M. A cell-based model of coagulation and the role of factor VIIa. Blood Rev. 2003;17(Suppl 1):S1–5.

    Article  PubMed  Google Scholar 

  8. Hoffman M, Monroe DM 3rd, Roberts HR. Activated factor VII activates factors IX and X on the surface of activated platelets: thoughts on the mechanism of action of high-dose activated factor VII. Blood Coagul Fibrinolysis. 1998;9(Suppl 1):S61–5.

    CAS  PubMed  Google Scholar 

  9. 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(5):812–8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cohen MJ, Call M, Nelson M, Calfee CS, Esmon CT, Brohi K, et al. Critical role of activated protein C in early coagulopathy and later organ failure, infection and death in trauma patients. Ann Surg. 2012;255(2):379–85.

    Article  PubMed  Google Scholar 

  11. Cohen MJ, Kutcher M, Redick B, Nelson M, Call M, Knudson MM, et al. Clinical and mechanistic drivers of acute traumatic coagulopathy. J Trauma Acute Care Surg. 2013;75(1 Suppl 1):S40–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Johansson PI, Stensballe J, Rasmussen LS, Ostrowski SR. A high admission syndecan-1 level, a marker of endothelial glycocalyx degradation, is associated with inflammation, protein C depletion, fibrinolysis, and increased mortality in trauma patients. Ann Surg. 2011;254(2):194–200.

    Article  PubMed  Google Scholar 

  13. Gonzalez Rodriguez E, Ostrowski SR, Cardenas JC, Baer LA, Tomasek JS, Henriksen HH, et al. Syndecan-1: a quantitative marker for the endotheliopathy of trauma. J Am Coll Surg. 2017;225(3):419–27.

    Article  PubMed  Google Scholar 

  14. Ostrowski SR, Johansson PI. Endothelial glycocalyx degradation induces endogenous heparinization in patients with severe injury and early traumatic coagulopathy. J Trauma Acute Care Surg. 2012;73(1):60–6.

    Article  CAS  PubMed  Google Scholar 

  15. Johansson PI, Henriksen HH, Stensballe J, Gybel-Brask M, Cardenas JC, Baer LA, et al. Traumatic endotheliopathy: a prospective observational study of 424 severely injured patients. Ann Surg. 2017;265(3):597–603.

    Article  PubMed  Google Scholar 

  16. Mosnier LO, Zlokovic BV, Griffin JH. The cytoprotective protein C pathway. Blood. 2007;109(8):3161–72.

    Article  CAS  PubMed  Google Scholar 

  17. D'Alessandro A, Slaughter AL, Peltz ED, Moore EE, Silliman CC, Wither M, et al. Trauma/hemorrhagic shock instigates aberrant metabolic flux through glycolytic pathways, as revealed by preliminary (13)C-glucose labeling metabolomics. J Transl Med. 2015;13:253.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Slaughter AL, D'Alessandro A, Moore EE, Banerjee A, Silliman CC, Hansen KC, et al. Glutamine metabolism drives succinate accumulation in plasma and the lung during hemorrhagic shock. J Trauma Acute Care Surg. 2016;81(6):1012–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. D'Alessandro A, Moore HB, Moore EE, Reisz JA, Wither MJ, Ghasasbyan A, et al. Plasma succinate is a predictor of mortality in critically injured patients. J Trauma Acute Care Surg. 2017;83(3):491–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Moore HB, Moore EE, Gonzalez E, Chapman MP, Chin TL, Silliman CC, et al. Hyperfibrinolysis, physiologic fibrinolysis, and fibrinolysis shutdown: the spectrum of postinjury fibrinolysis and relevance to antifibrinolytic therapy. J Trauma Acute Care Surg. 2014;77(6):811–7 discussion 7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Chapman MP, Moore EE, Moore HB, Gonzalez E, Gamboni F, Chandler JG, et al. Overwhelming tPA release, not PAI-1 degradation, is responsible for hyperfibrinolysis in severely injured trauma patients. J Trauma Acute Care Surg. 2016;80(1):16–23 discussion -5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Brohi K, Cohen MJ, Ganter MT, Schultz MJ, Levi M, Mackersie RC, et al. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma. 2008;64(5):1211–7 discussion 7.

    PubMed  Google Scholar 

  23. Cotton BA, Harvin JA, Kostousouv V, Minei KM, Radwan ZA, Schochl H, et al. Hyperfibrinolysis at admission is an uncommon but highly lethal event associated with shock and prehospital fluid administration. J Trauma Acute Care Surg. 2012;73(2):365–70 discussion 70.

    Article  CAS  PubMed  Google Scholar 

  24. Kashuk JL, Moore EE, Sawyer M, Wohlauer M, Pezold M, Barnett C, et al. Primary fibrinolysis is integral in the pathogenesis of the acute coagulopathy of trauma. Ann Surg. 2010;252(3):434–42 discussion 43-4.

    Article  PubMed  Google Scholar 

  25. Ives C, Inaba K, Branco BC, Okoye O, Schochl H, Talving P, et al. Hyperfibrinolysis elicited via thromboelastography predicts mortality in trauma. Journal of the American College of Surgeons. 2012;215(4):496–502.

    Article  PubMed  Google Scholar 

  26. Kutcher ME, Cripps MW, McCreery RC, Crane IM, Greenberg MD, Cachola LM, et al. Criteria for empiric treatment of hyperfibrinolysis after trauma. The journal of trauma and acute care surgery. 2012;73(1):87–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Levrat A, Gros A, Rugeri L, Inaba K, Floccard B, Negrier C, et al. Evaluation of rotation thrombelastography for the diagnosis of hyperfibrinolysis in trauma patients. Br J Anaesth. 2008;100(6):792–7.

    Article  CAS  PubMed  Google Scholar 

  28. collaborators C-t, Shakur H, Roberts I, Bautista R, Caballero J, Coats T, et al. 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(9734):23–32.

    Article  CAS  Google Scholar 

  29. Napolitano LM. Prehospital tranexamic acid: what is the current evidence? Trauma Surg Acute Care Open. 2017;2(1):e000056.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Moore HB, Moore EE, Liras IN, Gonzalez E, Harvin JA, Holcomb JB, et al. Acute fibrinolysis shutdown after injury occurs frequently and increases mortality: a multicenter evaluation of 2,540 severely injured patients. J Am Coll Surg. 2016;222(4):347–55.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Moore EE, Moore HB, Gonzalez E, Chapman MP, Hansen KC, Sauaia A, et al. Postinjury fibrinolysis shutdown: rationale for selective tranexamic acid. J Trauma Acute Care Surg. 2015;78(6 Suppl 1):S65–9.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Macko AR, Moore HB, Cap AP, Meledeo MA, Moore EE, Sheppard FR. Tissue injury suppresses fibrinolysis after hemorrhagic shock in nonhuman primates (rhesus macaque). J Trauma Acute Care Surg. 2017;82(4):750–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Moore HB, Moore EE, Lawson PJ, Gonzalez E, Fragoso M, Morton AP, et al. Fibrinolysis shutdown phenotype masks changes in rodent coagulation in tissue injury versus hemorrhagic shock. Surgery. 2015;158(2):386–92.

    Article  PubMed  Google Scholar 

  34. Moore HB, Moore EE, Huebner BR, Dzieciatkowska M, Stettler GR, Nunns GR, et al. Fibrinolysis shutdown is associated with a fivefold increase in mortality in trauma patients lacking hypersensitivity to tissue plasminogen activator. J Trauma Acute Care Surg. 2017;83(6):1014–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Innes D, Sevitt S. Coagulation and fibrinolysis in injured patients. J Clin Pathol. 1964;17:1–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Kluft C, Verheijen JH, Jie AF, Rijken DC, Preston FE, Sue-Ling HM, et al. The postoperative fibrinolytic shutdown: a rapidly reverting acute phase pattern for the fast-acting inhibitor of tissue-type plasminogen activator after trauma. Scand J Clin Lab Invest. 1985;45(7):605–10.

    Article  CAS  PubMed  Google Scholar 

  37. Weinberg RB. Lipoprotein metabolism: hormonal regulation. Hosp Pract (Off Ed). 1987;22(6):223–7 30, 33-4 passin.

    Article  CAS  Google Scholar 

  38. Meizoso JP, Karcutskie CA, Ray JJ, Namias N, Schulman CI, Proctor KG. Persistent fibrinolysis shutdown is associated with increased mortality in severely injured trauma patients. J Am Coll Surg. 2017;224(4):575–82.

    Article  PubMed  Google Scholar 

  39. Leeper CM, Neal MD, McKenna C, Sperry JL, Gaines BA. Abnormalities in fibrinolysis at the time of admission are associated with deep vein thrombosis, mortality, and disability in a pediatric trauma population. J Trauma Acute Care Surg. 2017;82(1):27–34.

    Article  CAS  PubMed  Google Scholar 

  40. Cardenas JC, Wade CE, Cotton BA, George MJ, Holcomb JB, Schreiber MA, et al. TEG lysis shutdown represents coagulopathy in bleeding trauma patients: analysis of the PROPPR cohort. Shock. 2019;51(3):273–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Ruhl H, Berens C, Winterhagen A, Muller J, Oldenburg J, Potzsch B. Label-free kinetic studies of hemostasis-related biomarkers including D-dimer using autologous serum transfusion. PLoS One. 2015;10(12):e0145012.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  42. Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA : the journal of the American Medical Association. 2015;313(5):471–82.

    Article  CAS  PubMed  Google Scholar 

  43. Moore HB, Moore EE, Chapman MP, McVaney K, Bryskiewicz G, Blechar R, et al. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. Lancet. 2018;392(10144):283–91.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Sperry JL, Guyette FX, Brown JB, Yazer MH, Triulzi DJ, Early-Young BJ, et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Engl J Med. 2018;379(4):315–26.

    Article  PubMed  Google Scholar 

  45. Pati S, Peng Z, Wataha K, Miyazawa B, Potter DR, Kozar RA. Lyophilized plasma attenuates vascular permeability, inflammation and lung injury in hemorrhagic shock. PLoS One. 2018;13(2):e0192363.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  46. Pati S, Potter DR, Baimukanova G, Farrel DH, Holcomb JB, Schreiber MA. Modulating the endotheliopathy of trauma: factor concentrate versus fresh frozen plasma. J Trauma Acute Care Surg. 2016;80(4):576–84 discussion 84-5.

    Article  PubMed  Google Scholar 

  47. Davenport R, Manson J, De'Ath H, Platton S, Coates A, Allard S, et al. Functional definition and characterization of acute traumatic coagulopathy. Crit Care Med. 2011;39(12):2652–8.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Schlimp CJ, Voelckel W, Inaba K, Maegele M, Schochl H. Impact of fibrinogen concentrate alone or with prothrombin complex concentrate (+/- fresh frozen plasma) on plasma fibrinogen level and fibrin-based clot strength (FIBTEM) in major trauma: a retrospective study. Scand J Trauma Resusc Emerg Med. 2013;21:74.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Nienaber U, Innerhofer P, Westermann I, Schochl H, Attal R, Breitkopf R, et al. The impact of fresh frozen plasma vs coagulation factor concentrates on morbidity and mortality in trauma-associated haemorrhage and massive transfusion. Injury. 2011;42(7):697–701.

    Article  PubMed  Google Scholar 

  50. Rourke C, Curry N, Khan S, Taylor R, Raza I, Davenport R, et al. Fibrinogen levels during trauma hemorrhage, response to replacement therapy, and association with patient outcomes. J Thromb Haemost. 2012;10(7):1342–51.

    Article  CAS  PubMed  Google Scholar 

  51. Stinger HK, Spinella PC, Perkins JG, Grathwohl KW, Salinas J, Martini WZ, et al. The ratio of fibrinogen to red cells transfused affects survival in casualties receiving massive transfusions at an army combat support hospital. J Trauma. 2008;64(2 Suppl):S79–85 discussion S.

    CAS  PubMed  Google Scholar 

  52. Curry N, Rourke C, Davenport R, Beer S, Pankhurst L, Deary A, et al. Early cryoprecipitate for major haemorrhage in trauma: a randomised controlled feasibility trial. Br J Anaesth. 2015;115(1):76–83.

    Article  CAS  PubMed  Google Scholar 

  53. Jeger V, Willi S, Liu T, Yeh DD, De Moya M, Zimmermann H, et al. The Rapid TEG alpha-Angle may be a sensitive predictor of transfusion in moderately injured blunt trauma patients. ScientificWorldJournal. 2012;2012:821794.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Harr JN, Moore EE, Ghasabyan A, Chin TL, Sauaia A, Banerjee A, et al. Functional fibrinogen assay indicates that fibrinogen is critical in correcting abnormal clot strength following trauma. Shock. 2013;39(1):45–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Schochl H, Cotton B, Inaba K, Nienaber U, Fischer H, Voelckel W, et al. FIBTEM provides early prediction of massive transfusion in trauma. Crit Care. 2011;15(6):R265.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Song JG, Jeong SM, Jun IG, Lee HM, Hwang GS. Five-minute parameter of thromboelastometry is sufficient to detect thrombocytopenia and hypofibrinogenaemia in patients undergoing liver transplantation. Br J Anaesth. 2014;112(2):290–7.

    Article  CAS  PubMed  Google Scholar 

  57. Crash-2 Collaborators IBS. Effect of tranexamic acid in traumatic brain injury: a nested randomised, placebo controlled trial (CRASH-2 Intracranial Bleeding Study). BMJ. 2011;343:d3795.

  58. Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study. Arch Surg. 2012;147(2):113–9.

    Article  CAS  PubMed  Google Scholar 

  59. Guyette FX, Brown JB, Zenati MS, Early-Young BJ, Adams PW, Eastridge BJ, et al. Tranexamic acid during prehospital transport in patients at risk for hemorrhage after injury: a double-blind, placebo-controlled, randomized clinical trial. JAMA Surgery. 2020.

  60. Chapman MP, Moore EE, Ramos CR, Ghasabyan A, Harr JN, Chin TL, et al. Fibrinolysis greater than 3% is the critical value for initiation of antifibrinolytic therapy. J Trauma Acute Care Surg. 2013;75(6):961–7 discussion 7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Baksaas-Aasen K, Van Dieren S, Balvers K, Juffermans NP, Naess PA, Rourke C, et al. Data-driven development of ROTEM and TEG algorithms for the management of trauma hemorrhage: a prospective observational multicenter study. Ann Surg. 2018.

  62. Moore HB, Moore EE, Huebner BR, Stettler GR, Nunns GR, Einersen PM, et al. Tranexamic acid is associated with increased mortality in patients with physiological fibrinolysis. J Surg Res. 2017;220:438–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. collaborators C-t. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Lancet. 2019;394(10210):1713–23.

    Article  Google Scholar 

  64. Rowell SE, Meier EN, McKnight B, Kannas D, May S, Sheehan K, et al. Effect of out-of-hospital tranexamic acid vs placebo on 6-month functional neurologic outcomes in patients with moderate or severe traumatic brain injury. JAMA. 2020;324(10):961–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Dickneite G, Dorr B, Kaspereit F, Tanaka KA. Prothrombin complex concentrate versus recombinant factor VIIa for reversal of hemodilutional coagulopathy in a porcine trauma model. J Trauma. 2010;68(5):1151–7.

    CAS  PubMed  Google Scholar 

  66. Schochl H, Nienaber U, Hofer G, Voelckel W, Jambor C, Scharbert G, et al. Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM)-guided administration of fibrinogen concentrate and prothrombin complex concentrate. Crit Care. 2010;14(2):R55.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Schochl H, Nienaber U, Maegele M, Hochleitner G, Primavesi F, Steitz B, et al. Transfusion in trauma: thromboelastometry-guided coagulation factor concentrate-based therapy versus standard fresh frozen plasma-based therapy. Crit Care. 2011;15(2):R83.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Innerhofer P, Westermann I, Tauber H, Breitkopf R, Fries D, Kastenberger T, et al. The exclusive use of coagulation factor concentrates enables reversal of coagulopathy and decreases transfusion rates in patients with major blunt trauma. Injury. 2013;44(2):209–16.

    Article  PubMed  Google Scholar 

  69. Hess JR, Lindell AL, Stansbury LG, Dutton RP, Scalea TM. The prevalence of abnormal results of conventional coagulation tests on admission to a trauma center. Transfusion. 2009;49(1):34–9.

    Article  PubMed  Google Scholar 

  70. Kutcher ME, Redick BJ, McCreery RC, Crane IM, Greenberg MD, Cachola LM, et al. Characterization of platelet dysfunction after trauma. J Trauma Acute Care Surg. 2012;73(1):13–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Bochsen L, Wiinberg B, Kjelgaard-Hansen M, Steinbruchel DA, Johansson PI. Evaluation of the TEG platelet mapping assay in blood donors. Thromb J. 2007;5:3.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  72. Pries AR, Neuhaus D, Gaehtgens P. Blood viscosity in tube flow: dependence on diameter and hematocrit. Am J Physiol. 1992;263(6 Pt 2):H1770–8.

    CAS  PubMed  Google Scholar 

  73. Kroll MH, Michaelis LC, Verstovsek S. Mechanisms of thrombogenesis in polycythemia vera. Blood Rev. 2015;29(4):215–21.

    Article  CAS  PubMed  Google Scholar 

  74. Flamm MH, Diamond SL. Multiscale systems biology and physics of thrombosis under flow. Ann Biomed Eng. 2012;40(11):2355–64.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Klatt C, Kruger I, Zey S, Krott KJ, Spelleken M, Gowert NS, et al. Platelet-RBC interaction mediated by FasL/FasR induces procoagulant activity important for thrombosis. J Clin Invest. 2018;128(9):3906–25.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Spinella PC, Perkins JG, Grathwohl KW, Beekley AC, Holcomb JB. Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries. J Trauma. 2009;66(4 Suppl):S69–76.

    PubMed  PubMed Central  Google Scholar 

  77. Pidcoke HF, McFaul SJ, Ramasubramanian AK, Parida BK, Mora AG, Fedyk CG, et al. Primary hemostatic capacity of whole blood: a comprehensive analysis of pathogen reduction and refrigeration effects over time. Transfusion. 2013;53(Suppl 1):137S–49S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Nair PM, Pandya SG, Dallo SF, Reddoch KM, Montgomery RK, Pidcoke HF, et al. Platelets stored at 4 degrees C contribute to superior clot properties compared to current standard-of-care through fibrin-crosslinking. Br J Haematol. 2017;178(1):119–29.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Nair PM, Pidcoke HF, Cap AP, Ramasubramanian AK. Effect of cold storage on shear-induced platelet aggregation and clot strength. J Trauma Acute Care Surg. 2014;77(3 Suppl 2):S88–93.

    Article  PubMed  Google Scholar 

  80. Ketter PM, Kamucheka R, Arulanandam B, Akers K, Cap AP. Platelet enhancement of bacterial growth during room temperature storage: mitigation through refrigeration. Transfusion. 2019;59(S2):1479–89.

    Article  PubMed  Google Scholar 

  81. Leeper CM, Yazer MH, Cladis FP, Saladino R, Triulzi DJ, Gaines BA. Cold-stored whole blood platelet function is preserved in injured children with hemorrhagic shock. J Trauma Acute Care Surg. 2019;87(1):49–53.

    Article  PubMed  Google Scholar 

  82. Seheult JN, Bahr M, Anto V, Alarcon LH, Corcos A, Sperry JL, et al. Safety profile of uncrossmatched, cold-stored, low-titer, group O+ whole blood in civilian trauma patients. Transfusion. 2018;58(10):2280–8.

    Article  CAS  PubMed  Google Scholar 

  83. Jackson B. Murphy, Colin, Fontaine, Magali J. Current state of whole blood transfusion for civilian trauma resuscitation. Transfusion. 2020;60(S3):S45–52.

    Article  PubMed  Google Scholar 

  84. Cotton BA, Podbielski J, Camp E, Welch T, del Junco D, Bai Y, et al. A randomized controlled pilot trial of modified whole blood versus component therapy in severely injured patients requiring large volume transfusions. Ann Surg. 2013;258(4):527–32 discussion 32-3.

    Article  PubMed  Google Scholar 

  85. Seheult JN, Anto V, Alarcon LH, Sperry JL, Triulzi DJ, Yazer MH. Clinical outcomes among low-titer group O whole blood recipients compared to recipients of conventional components in civilian trauma resuscitation. Transfusion. 2018;58(8):1838–45.

    Article  PubMed  Google Scholar 

  86. Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernandez-Mondejar E, et al. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care. 2013;17(2):R76.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2013;30(6):270–382.

    Article  PubMed  Google Scholar 

  88. Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, et al. Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 2015;162(3):205–13.

    Article  PubMed  Google Scholar 

  89. Borgman MA, Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63(4):805–13.

    PubMed  Google Scholar 

  90. Duchesne JC, Barbeau JM, Islam TM, Wahl G, Greiffenstein P, McSwain NE Jr. Damage control resuscitation: from emergency department to the operating room. Am Surg. 2011;77(2):201–6.

    Article  PubMed  Google Scholar 

  91. Cotton BA, Reddy N, Hatch QM, LeFebvre E, Wade CE, Kozar RA, et al. Damage control resuscitation is associated with a reduction in resuscitation volumes and improvement in survival in 390 damage control laparotomy patients. Ann Surg. 2011;254(4):598–605.

    Article  PubMed  Google Scholar 

  92. Holcomb JB, Wade CE, Michalek JE, Chisholm GB, Zarzabal LA, Schreiber MA, et al. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg. 2008;248(3):447–58.

    Article  PubMed  Google Scholar 

  93. Holcomb JB, del Junco DJ, Fox EE, Wade CE, Cohen MJ, Schreiber MA, et al. The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA surgery. 2013;148(2):127–36.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Davenport R, Curry N, Manson J, De'Ath H, Coates A, Rourke C, et al. Hemostatic effects of fresh frozen plasma may be maximal at red cell ratios of 1:2. J Trauma. 2011;70(1):90–5 discussion 5-6.

    PubMed  Google Scholar 

  95. Kashuk JL, Moore EE, Johnson JL, Haenel J, Wilson M, Moore JB, et al. Postinjury life threatening coagulopathy: is 1:1 fresh frozen plasma:packed red blood cells the answer? J Trauma. 2008;65(2):261–70 discussion 70-1.

    PubMed  Google Scholar 

  96. Gonzalez E, Moore EE, Moore HB, Chapman MP, Chin TL, Ghasabyan A, et al. Goal-directed hemostatic resuscitation of trauma-induced coagulopathy: a pragmatic randomized clinical trial comparing a viscoelastic assay to conventional coagulation assays. Ann Surg. 2016;263(6):1051–9.

    Article  PubMed  Google Scholar 

  97. Kashuk JL, Moore EE, Wohlauer M, Johnson JL, Pezold M, Lawrence J, et al. Initial experiences with point-of-care rapid thrombelastography for management of life-threatening postinjury coagulopathy. Transfusion. 2012;52(1):23–33.

    Article  PubMed  Google Scholar 

  98. Plotkin AJ, Wade CE, Jenkins DH, Smith KA, Noe JC, Park MS, et al. A reduction in clot formation rate and strength assessed by thrombelastography is indicative of transfusion requirements in patients with penetrating injuries. J Trauma. 2008;64(2 Suppl):S64–8.

    PubMed  Google Scholar 

  99. Johansson PI, Stensballe J. Effect of Haemostatic Control Resuscitation on mortality in massively bleeding patients: a before and after study. Vox Sang. 2009;96(2):111–8.

    Article  CAS  PubMed  Google Scholar 

  100. Nunns GR, Moore EE, Stettler GR, Moore HB, Ghasabyan A, Cohen M, et al. Empiric transfusion strategies during life-threatening hemorrhage. Surgery. 2018;164(2):306–11.

    Article  PubMed  Google Scholar 

  101. Einersen PM, Moore EE, Chapman MP, Moore HB, Gonzalez E, Silliman CC, et al. Rapid thrombelastography thresholds for goal-directed resuscitation of patients at risk for massive transfusion. The journal of trauma and acute care surgery. 2017;82(1):114–9.

    Article  PubMed  PubMed Central  Google Scholar 

  102. Moore HB, Gando S, Iba T, Kim PY, Yeh CH, Brohi K, et al. Defining trauma-induced coagulopathy with respect to future implications for patient management: communication from the SSC of the ISTH. Journal of thrombosis and haemostasis : JTH. 2020;18(3):740–7.

    Article  PubMed  Google Scholar 

  103. Moore HB, Moore EE, Neal MD, Sheppard FR, Kornblith LZ, Draxler DF, et al. Fibrinolysis shutdown in trauma: historical review and clinical implications. Anesth Analg. 2019;129(3):762–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  104. Coleman JR, Kay AB, Moore EE, Moore HB, Gonzalez E, Majercik S, et al. It’s sooner than you think: blunt solid organ injury patients are already hypercoagulable upon hospital admission - results of a bi-institutional, prospective study. American journal of surgery. 2019;218(6):1065–73.

    Article  PubMed  PubMed Central  Google Scholar 

  105. Sambasivan CN, Kunio NR, Nair PV, Zink KA, Michalek JE, Holcomb JB, et al. High ratios of plasma and platelets to packed red blood cells do not affect mortality in nonmassively transfused patients. J Trauma. 2011;71(2 Suppl 3):S329–36.

    PubMed  Google Scholar 

  106. Johnston LR, Rodriguez CJ, Elster EA, Bradley MJ. Evaluation of military use of tranexamic acid and associated thromboembolic events. JAMA surgery. 2018;153(2):169–75.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 E. 17th Ave, C-310, Room 6602, Aurora, CO, 80045, USA

    Navin G. Vigneshwar, Hunter B. Moore & Ernest E. Moore

  2. Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA

    Ernest E. Moore

Authors
  1. Navin G. Vigneshwar
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  2. Hunter B. Moore
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  3. Ernest E. Moore
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Correspondence to Navin G. Vigneshwar.

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Conflict of Interest

Navin G. Vigneshwar is supported, in part, by a T32 Resident Teaching Grant from the National Institutes of Health (NIH). Hunter B. Moore has received research support from Haemonetics and Instrumentation Laboratory Company, and has shared intellectual property with Haemonetics. Ernest E. Moore has received research support from Haemonetics, Instrumentation Laboratory Company, HemoSonics, Stago, and Diapharma, and is a Co-Founder of Thrombo Therapeutics.

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Vigneshwar, N.G., Moore, H.B. & Moore, E.E. Trauma-Induced Coagulopathy: Diagnosis and Management in 2020. Curr Anesthesiol Rep 11, 363–372 (2021). https://doi.org/10.1007/s40140-021-00438-5

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