The Pathophysiology and Management of Acute Traumatic Coagulopathy

Abstract

Acute traumatic coagulopathy (ATC) is commonly seen among patients with severe injury and will lead to uncontrolled bleeding diathesis, which is an important contributor to trauma death. During the past 10 years, the understanding of the mechanism causing ATC has changed rapidly. The mechanisms for ATC are complicated. To date, the possible mechanisms include activation of protein C, shedding of endothelial glycocalyx, catecholamine release, platelet dysfunction, primary, and secondary fibrinolysis, with tissue injury and hypoperfusion as the triggers. Classic factors such as dilution, acidosis, and hypothermia can further aggravate the coagulopathy. Inflammation may have a potential effect on the onset and prognosis of ATC. With the aid of diagnostic device, the outcome can be improved through early and customized treatment. Antifibrinolytics such as tranexamic acid has some benefits in patients with bleeding trauma, especially in the early time. This review presents the current understanding of ATC mechanisms and management.

Assessment of hemostatic changes in a model of acute hemorrhage in dogs

“…Some people affected by trauma may have ongoing hemorrhage associated with an acquired dysregulation of coagulation, termed the acute traumatic coagulopathy (ATC). Acute traumatic coagulopathy is thought to be a consequence of acute tissue damage and hypoperfusion . Mechanisms associated with ATC include excessive intrinsic anticoagulation, consumption of coagulation factors, platelet dysfunction, and hyperfibrinolysis .…”

“…Acute traumatic coagulopathy is thought to be a consequence of acute tissue damage and hypoperfusion . Mechanisms associated with ATC include excessive intrinsic anticoagulation, consumption of coagulation factors, platelet dysfunction, and hyperfibrinolysis . The specific hemostatic changes in individuals with ATC, however, are variable and unpredictable .…”

“…[9][10][11][12][13] Mechanisms associated with ATC include excessive intrinsic anticoagulation, consumption of coagulation factors, platelet dysfunction, and hyperfibrinolysis. 12 The specific hemostatic changes in individuals with ATC, however, are variable and unpredictable. 13 This state may be exacerbated by acidemia, hypothermia, and the dilutional effects of aggressive fluid resuscitation.…”

Research progress on combat trauma treatment in cold regions

“…Duan and colleagues . [ 15 ] argued that acute traumatic coagulopathy (ATC) is commonly seen among patients with severe injury and leads to uncontrolled bleeding diathesis, which is an important contributor to trauma death.…”

Efeito da N-acetilcisteína associada ao ácido tranexâmico na coagulopatia em modelo suíno de politrauma

“…Ela está presente na forma inativa no plasma e pode ser convertida em sua forma ativa por diferentes vias 91 . Na hipoperfusão tecidual que ocorre no trauma a via trombina-trombomodulina é responsável pela ativação da Proteína C …”