Trauma-induced coagulopathy (TIC) is a recently described condition which traditionally has been diagnosed by the common coagulation tests (CCTs) such as prothrombin time/international normalized ratio (PT/INR), activated partial thromboplastin time (aPTT), platelet count, and fibrinogen levels. The varying sensitivity and specificity of these CCTs have led trauma coagulation researchers and clinicians to use Viscoelastic Tests (VET) such as Thromboelastography (TEG) to provide Targeted Thromboelastographic Hemostatic and Adjunctive Therapy (TTHAT) in a goal directed fashion to those trauma patients in need of hemostatic resuscitation. This review describes the utility of VETs, in particular, TEG, to provide TTHAT in trauma and acquired non-trauma-induced coagulopathy.Keywords: Thromboelastography, point-of-care, acquired coagulopathy, blood component therapy, systemic hemostatic agents, trauma-induced coagulopathy, hemostatic resuscitation, tranexamic acid, targeted pharmacologic therapy. TRAUMA INDUCED COAGULOPATHY AND AC-QUIRED COAGULOPATHY IntroductionCoagulopathy is found in approximately 25% of severely injured trauma patients on admission to the emergency department (ED). Patients with Trauma-Induced Coagulopathy (TIC) are at a higher risk for increased transfusion requirements and death compared to those without TIC [1][2][3][4][5]. The etiology of TIC has been a matter of speculation. Trauma induced disturbances of compensatory activation of activated protein C (APC), hypofibrinogenemia, Tissue Factor (TF) release, coagulation factor consumption and dilution, platelet dysfunction, and fibrinolysis have been cited as possible causes of TIC [1][2][3][4][5][6][7][8][9]. In addition, it has been argued by Gando and others that TIC is a variant of disseminated intravascular coagulation [10,11]. Most recently, Dobson et al. have described the etiology of TIC in relation to four paradigms of hemostatic derangement which are: 1) the DIC/ consumption/ fibrinolysis hypothesis 2) the activated protein-C hypothesis 3) the glycocalyx hypothesis and 4) the "fibrinogencentric" hypothesis. These hypotheses are not mutually exclusive. It is necessary to refer to this theoretical aspect of

This paper reviews the application of tranexamic acid, an antifibrinolytic, to trauma. CRASH-2, a large randomized controlled trial, was the first to show a reduction in mortality and recommend tranexamic acid use in bleeding trauma patients. However, this paper was not without controversy. Its patient recruitment, methodology, and conductance in moderate-to-low income countries cast doubt on its ability to be applied to trauma protocols in countries with mature trauma networks. In addition to traditional vetting in scientific, peer-reviewed journals, CRASH-2 came about at a time when advances in communication technology allowed debate and influence to be leveraged in new forms, specifically through the use of multimedia campaigns, social media, and Internet blogs. This paper presents a comprehensive view of tranexamic acid utilization in trauma from peer-reviewed evidence to novel multimedia influences.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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