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Pathophysiology: Trauma-Induced Coagulopathy

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Textbook of Polytrauma Management

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Abstract

Trauma-induced coagulopathy (TIC) is an alteration in the body’s coagulation capacity that is attributable to injury and manifests in a spectrum of phenotypes which are dynamic and time dependent. One end of the spectrum is hypocoagulability, which results in poorly hemostatic clots causing difficult to control hemorrhage. The hypercoagulable end of the spectrum can result in micro- and macrovascular thrombosis leading to a deep vein thrombosis, pulmonary embolism, acute respiratory distress syndrome, and multisystem organ failure. The pathophysiology behind TIC is complex and involves an intricate interplay between diminished thrombin generation, platelet dysfunction, vascular endothelial cell dysfunction, fibrinogen depletion, and dysregulated fibrinolysis. Improved understanding of the mechanisms behind TIC will allow for more personalized and precise treatment of trauma patients.

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References

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

    Article  PubMed  Google Scholar 

  2. 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 

  3. Sumislawski JJ, Christie SA, Kornblith LZ, Stettler GR, Nunns GR, Moore HB, Moore EE, Silliman CC, Sauaia A, Callcut RA, 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 

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

    Article  CAS  PubMed  Google Scholar 

  5. 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 

  6. 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 

  7. Hoffman M, Monroe DM 3rd. A cell-based model of hemostasis. Thromb Haemost. 2001;85(6):958–65.

    Article  CAS  PubMed  Google Scholar 

  8. Li Z, Delaney MK, O’Brien KA, Du X. Signaling during platelet adhesion and activation. Arterioscler Thromb Vasc Biol. 2010;30(12):2341–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Wolberg AS, Campbell RA. Thrombin generation, fibrin clot formation and hemostasis. Transfus Apher Sci. 2008;38(1):15–23.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Crawley JT, Zanardelli S, Chion CK, Lane DA. The central role of thrombin in hemostasis. J Thromb Haemost. 2007;5(Suppl 1):95–101.

    Article  CAS  PubMed  Google Scholar 

  11. Rizoli SB, Scarpelini S, Callum J, Nascimento B, Mann KG, Pinto R, Jansen J, Tien HC. Clotting factor deficiency in early trauma-associated coagulopathy. J Trauma. 2011;71(5 Suppl 1):S427–34.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Woolley T, Gwyther R, Parmar K, Kirkman E, Watts S, Midwinter M, Lucca JD, Hunt BJ. A prospective observational study of acute traumatic coagulopathy in traumatic bleeding from the battlefield. Transfusion. 2020;60(Suppl 3):S52–61.

    CAS  PubMed  Google Scholar 

  13. Moore HB, Moore EE, Chapman MP, McVaney K, Bryskiewicz G, Blechar R, Chin T, Burlew CC, Pieracci F, West FB, 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 

  14. Dunbar NM, Chandler WL. Thrombin generation in trauma patients. Transfusion. 2009;49(12):2652–60.

    Article  CAS  PubMed  Google Scholar 

  15. Cardenas JC, Rahbar E, Pommerening MJ, Baer LA, Matijevic N, Cotton BA, Holcomb JB, Wade CE. Measuring thrombin generation as a tool for predicting hemostatic potential and transfusion requirements following trauma. J Trauma Acute Care Surg. 2014;77(6):839–45.

    Article  CAS  PubMed  Google Scholar 

  16. Coleman JR, Moore EE, Samuels JM, Ryon JJ, Nelson JT, Olson A, Caus S, Bartley MG, Vigneshwar NG, Cohen MJ, et al. Whole blood thrombin generation is distinct from plasma thrombin generation in healthy volunteers and after severe injury. Surgery. 2019;166(6):1122–7.

    Article  PubMed  Google Scholar 

  17. Coleman JR, Moore EE, Samuels JM, Cohen MJ, Silliman CC, Ghasabyan A, Chandler J, Butenas S. Whole blood thrombin generation in severely injured patients requiring massive transfusion. J Am Coll Surg. 2021;

    Google Scholar 

  18. Park MS, Spears GM, Bailey KR, Xue A, Ferrara MJ, Headlee A, Dhillon SK, Jenkins DH, Zietlow SP, Harmsen WS, et al. Thrombin generation profiles as predictors of symptomatic venous thromboembolism after trauma: a prospective cohort study. J Trauma Acute Care Surg. 2017;83(3):381–7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Nachman RL, Rafii S. Platelets, petechiae, and preservation of the vascular wall. N Engl J Med. 2008;359(12):1261–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Weyrich AS, Zimmerman GA. Platelets: signaling cells in the immune continuum. Trends Immunol. 2004;25(9):489–95.

    Article  CAS  PubMed  Google Scholar 

  21. Ding N, Chen G, Hoffman R, Loughran PA, Sodhi CP, Hackam DJ, Billiar TR, Neal MD. Toll-like receptor 4 regulates platelet function and contributes to coagulation abnormality and organ injury in hemorrhagic shock and resuscitation. Circ Cardiovasc Genet. 2014;7(5):615–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Tweardy DJ, Khoshnevis MR, Yu B, Mastrangelo MA, Hardison EG, Lopez JA. Essential role for platelets in organ injury and inflammation in resuscitated hemorrhagic shock. Shock. 2006;26(4):386–90.

    Article  PubMed  Google Scholar 

  23. Moore HB, Moore EE, Gonzalez E, Hansen KC, Dzieciatkowska M, Chapman MP, Sauaia A, West B, Banerjee A, Silliman CC. Hemolysis exacerbates hyperfibrinolysis, whereas platelolysis shuts down fibrinolysis: evolving concepts of the spectrum of fibrinolysis in response to severe injury. Shock. 2015;43(1):39–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Mazepa M, Hoffman M, Monroe D. Superactivated platelets: thrombus regulators, thrombin generators, and potential clinical targets. Arterioscler Thromb Vasc Biol. 2013;33(8):1747–52.

    Article  CAS  PubMed  Google Scholar 

  25. Kral JB, Schrottmaier WC, Salzmann M, Assinger A. Platelet interaction with innate immune cells. Transfus Med Hemother. 2016;43(2):78–88.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 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 

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Jacoby RC, Owings JT, Holmes J, Battistella FD, Gosselin RC, Paglieroni TG. Platelet activation and function after trauma. J Trauma. 2001;51(4):639–47.

    Article  CAS  PubMed  Google Scholar 

  29. Starr NE, Matthay ZA, Fields AT, Nunez-Garcia B, Callcut RA, Cohen MJ, Kornblith LZ. Identification of injury and shock driven effects on ex vivo platelet aggregometry: a cautionary tale of phenotyping. J Trauma Acute Care Surg. 2020;89(1):20–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Moore HB, Moore EE, Chapman MP, Gonzalez E, Slaughter AL, Morton AP, D’Alessandro A, Hansen KC, Sauaia A, Banerjee A, et al. Viscoelastic measurements of platelet function, not fibrinogen function, predicts sensitivity to tissue-type plasminogen activator in trauma patients. J Thromb Haemost. 2015;13(10):1878–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Verni CC, Davila A Jr, Balian S, Sims CA, Diamond SL. Platelet dysfunction during trauma involves diverse signaling pathways and an inhibitory activity in patient-derived plasma. J Trauma Acute Care Surg. 2019;86(2):250–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Vogel S, Bodenstein R, Chen Q, Feil S, Feil R, Rheinlaender J, Schaffer TE, Bohn E, Frick JS, Borst O, et al. Platelet-derived HMGB1 is a critical mediator of thrombosis. J Clin Invest. 2015;125(12):4638–54.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Benhamou Y, Favre J, Musette P, Renet S, Thuillez C, Richard V, Tamion F. Toll-like receptors 4 contribute to endothelial injury and inflammation in hemorrhagic shock in mice. Crit Care Med. 2009;37(5):1724–8.

    Article  CAS  PubMed  Google Scholar 

  34. Vulliamy P, Kornblith LZ, Kutcher ME, Cohen MJ, Brohi K, Neal MD. Alterations in platelet behavior after major trauma: adaptive or maladaptive? Platelets. 2020;1-10

    Google Scholar 

  35. Kozar RA, Pati S. Syndecan-1 restitution by plasma after hemorrhagic shock. J Trauma Acute Care Surg. 2015;78(6 Suppl 1):S83–6.

    Article  PubMed  PubMed Central  Google Scholar 

  36. 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 

  37. Jenkins DH, Rappold JF, Badloe JF, Berseus O, Blackbourne L, Brohi KH, Butler FK, Cap AP, Cohen MJ, Davenport R, et al. Trauma hemostasis and oxygenation research position paper on remote damage control resuscitation: definitions, current practice, and knowledge gaps. Shock. 2014;41(Suppl 1):3–12.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Haywood-Watson RJ, Holcomb JB, Gonzalez EA, Peng Z, Pati S, Park PW, Wang W, Zaske AM, Menge T, Kozar RA. Modulation of syndecan-1 shedding after hemorrhagic shock and resuscitation. PLoS One. 2011;6(8):e23530.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. 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 

  40. 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 

  41. Chesebro BB, Rahn P, Carles M, Esmon CT, Xu J, Brohi K, Frith D, Pittet JF, Cohen MJ. Increase in activated protein C mediates acute traumatic coagulopathy in mice. Shock. 2009;32(6):659–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Cohen MJ, Call M, Nelson M, Calfee CS, Esmon CT, Brohi K, Pittet JF. 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 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  45. 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(7):1342–51.

    Article  CAS  PubMed  Google Scholar 

  46. Hagemo JS, Stanworth S, Juffermans NP, Brohi K, Cohen M, Johansson PI, Roislien J, Eken T, Naess PA, Gaarder C. Prevalence, predictors and outcome of hypofibrinogenaemia in trauma: a multicentre observational study. Crit Care. 2014;18(2):R52.

    Article  PubMed  PubMed Central  Google Scholar 

  47. 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(2):290–7.

    Article  PubMed  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, Maegele M. 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. Stinger HK, Spinella PC, Perkins JG, Grathwohl KW, Salinas J, Martini WZ, Hess JR, Dubick MA, Simon CD, Beekley AC, 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 

  51. Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, Komadina R, Maegele M, Nardi G, Riddez L, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019;23(1):98.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Fries D, Martini WZ. Role of fibrinogen in trauma-induced coagulopathy. Br J Anaesth. 2010;105(2):116–21.

    Article  CAS  PubMed  Google Scholar 

  53. Martini WZ. The effects of hypothermia on fibrinogen metabolism and coagulation function in swine. Metabolism. 2007;56(2):214–21.

    Article  CAS  PubMed  Google Scholar 

  54. Martini WZ, Holcomb JB. Acidosis and coagulopathy: the differential effects on fibrinogen synthesis and breakdown in pigs. Ann Surg. 2007;246(5):831–5.

    Article  PubMed  Google Scholar 

  55. Schlimp CJ, Schochl H. The role of fibrinogen in trauma-induced coagulopathy. Hamostaseologie. 2014;34(1):29–39.

    Article  CAS  PubMed  Google Scholar 

  56. Moore HB, Moore EE, Gonzalez E, Chapman MP, Chin TL, Silliman CC, Banerjee A, Sauaia A. 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 

  57. Chapman MP, Moore EE, Moore HB, Gonzalez E, Gamboni F, Chandler JG, Mitra S, Ghasabyan A, Chin TL, Sauaia A, 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 

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

    PubMed  Google Scholar 

  59. Cotton BA, Harvin JA, Kostousouv V, Minei KM, Radwan ZA, Schochl H, Wade CE, Holcomb JB, Matijevic N. 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 

  60. Kashuk JL, Moore EE, Sawyer M, Wohlauer M, Pezold M, Barnett C, Biffl WL, Burlew CC, Johnson JL, Sauaia A. 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 

  61. Ives C, Inaba K, Branco BC, Okoye O, Schochl H, Talving P, Lam L, Shulman I, Nelson J, Demetriades D. Hyperfibrinolysis elicited via thromboelastography predicts mortality in trauma. J Am Coll Surg. 2012;215(4):496–502.

    Article  PubMed  Google Scholar 

  62. Kutcher ME, Cripps MW, McCreery RC, Crane IM, Greenberg MD, Cachola LM, Redick BJ, Nelson MF, Cohen MJ. Criteria for empiric treatment of hyperfibrinolysis after trauma. J Trauma Acute Care Surg. 2012;73(1):87–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Levrat A, Gros A, Rugeri L, Inaba K, Floccard B, Negrier C, David JS. 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 

  64. Moore HB, Moore EE, Morton AP, Gonzalez E, Fragoso M, Chapman MP, Dzieciatkowska M, Hansen KC, Banerjee A, Sauaia A, et al. Shock-induced systemic hyperfibrinolysis is attenuated by plasma-first resuscitation. J Trauma Acute Care Surg. 2015;79(6):897–903; discussion-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Sillesen M, Johansson PI, Rasmussen LS, Jin G, Jepsen CH, Imam A, Hwabejire JO, Deperalta D, Duggan M, DeMoya M, et al. Fresh frozen plasma resuscitation attenuates platelet dysfunction compared with normal saline in a large animal model of multisystem trauma. J Trauma Acute Care Surg. 2014;76(4):998–1007.

    Article  CAS  PubMed  Google Scholar 

  66. Huber D, Cramer EM, Kaufmann JE, Meda P, Masse JM, Kruithof EK, Vischer UM. Tissue-type plasminogen activator (t-PA) is stored in Weibel-Palade bodies in human endothelial cells both in vitro and in vivo. Blood. 2002;99(10):3637–45.

    Article  CAS  PubMed  Google Scholar 

  67. Ostrowski SR, Henriksen HH, Stensballe J, Gybel-Brask M, Cardenas JC, Baer LA, Cotton BA, Holcomb JB, Wade CE, Johansson PI. Sympathoadrenal activation and endotheliopathy are drivers of hypocoagulability and hyperfibrinolysis in trauma: a prospective observational study of 404 severely injured patients. J Trauma Acute Care Surg. 2017;82(2):293–301.

    Article  PubMed  Google Scholar 

  68. Booth NA, Walker E, Maughan R, Bennett B. Plasminogen activator in normal subjects after exercise and venous occlusion: t-PA circulates as complexes with C1-inhibitor and PAI-1. Blood. 1987;69(6):1600–4.

    Article  CAS  PubMed  Google Scholar 

  69. Moore HB, Moore EE, Chapman MP, Hansen K, Cohen MJ, Pieracci FM, Chandler J, Sauaia A. Does tranexamic acid improve clot strength in severely injured patients who have elevated fibrin degradation products and low fibrinolytic activity, measured by thrombelastography? J Am Coll Surg. 2019;

    Google Scholar 

  70. Moore HB, Moore EE, Liras IN, Gonzalez E, Harvin JA, Holcomb JB, Sauaia A, Cotton BA. 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 

  71. Moore EE, Moore HB, Gonzalez E, Chapman MP, Hansen KC, Sauaia A, Silliman CC, Banerjee A. 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 

  72. Nguyen G, Horellou MH, Kruithof EK, Conard J, Samama MM. Residual plasminogen activator inhibitor activity after venous stasis as a criterion for hypofibrinolysis: a study in 83 patients with confirmed deep vein thrombosis. Blood. 1988;72(2):601–5.

    Article  CAS  PubMed  Google Scholar 

  73. Tipoe TL, Wu WKK, Chung L, Gong M, Dong M, Liu T, Roever L, Ho J, Wong MCS, Chan MTV, et al. Plasminogen activator inhibitor 1 for predicting sepsis severity and mortality outcomes: a systematic review and meta-analysis. Front Immunol. 2018;9:1218.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Gall LS, Vulliamy P, Gillespie S, Jones TF, Pierre RSJ, Breukers SE, Gaarder C, Juffermans NP, Maegele M, Stensballe J, et al. The S100A10 pathway mediates an occult Hyperfibrinolytic subtype in trauma patients. Ann Surg. 2019;269(6):1184–91.

    Article  PubMed  Google Scholar 

  75. Moore HB, Cohen MJ, Moore EE. Comment on “the S100A10 pathway mediates an occult Hyperfibrinolytic subtype in trauma patients”. Ann Surg. 2020;271(4):e110-e1.

    Article  Google Scholar 

  76. 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 

  77. Moore HB, Moore EE, Lawson PJ, Gonzalez E, Fragoso M, Morton AP, Gamboni F, Chapman MP, Sauaia A, Banerjee A, 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 

  78. Moore HB, Moore EE, Huebner BR, Dzieciatkowska M, Stettler GR, Nunns GR, Lawson PJ, Ghasabyan A, Chandler J, Banerjee A, 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 

  79. Coleman JR, Moore EE, Freeman K, Grubinger ND, Hennig GW, Cohen MJ, Samuels JM, Hansen K. Actin is associated with tissue injury in trauma patients and produces a hypercoagulable profile in vitro. J Trauma Acute Care Surg. 2020;89(1):87–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Gonzalez E, Moore EE, Moore HB, Chapman MP, Chin TL, Ghasabyan A, Wohlauer MV, Barnett CC, Bensard DD, Biffl WL, 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 

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Authors and Affiliations

  1. Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Navin Ganesh 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

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  1. Navin Ganesh Vigneshwar
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  2. Hunter B. Moore
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Correspondence to Navin Ganesh Vigneshwar .

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Editors and Affiliations

  1. Department of Trauma Surgery, University Hospital Zürich, Zürich, Switzerland

    Hans-Christoph Pape

  2. Department of Orthopaedic Surgery & Sports Medicine, The University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Joseph Borrelli Jr.

  3. Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA

    Ernest E. Moore

  4. Klinik für Traumatologie, University Hospital of Zürich, Zürich, Switzerland

    Roman Pfeifer

  5. Rocky Vista University, College of Osteopathic Medicine, Parker, CO, USA

    Philip F. Stahel

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Vigneshwar, N.G., Moore, H.B., Moore, E.E. (2022). Pathophysiology: Trauma-Induced Coagulopathy. In: Pape, HC., Borrelli Jr., J., Moore, E.E., Pfeifer, R., Stahel, P.F. (eds) Textbook of Polytrauma Management . Springer, Cham. https://doi.org/10.1007/978-3-030-95906-7_10

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