Acute coagulopathy of trauma: mechanism, identification and effect

被引:426
作者
Brohi, Karim
Cohen, Mitchell J.
Davenport, Ross A.
机构
[1] Royal London Hosp, Dept Surg, London E1 1BB, England
[2] Univ Calif San Francisco, San Francisco Gen Hosp, Dept Surg, San Francisco, CA 94143 USA
关键词
coagulopathy; massive transfusion; protein C; shock; trauma;
D O I
10.1097/MCC.0b013e3282f1e78f
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose of review Acute coagulopathy of trauma has only been described relatively recently. Developing early in the postinjury phase, it is associated with increased transfusion requirements and poor outcomes. This review examines the possible initiators, mechanism and clinical importance of acute coagulopathy. Recent findings Acute coagulopathy of trauma occurs in patients with shock and is characterized by a systemic anticoagulation and hyperfibrinolysis. Dilution, acidemia and consumption of coagulation proteases do not appear to be significant factors at this stage. There is evidence to implicate activation of the protein C pathway in this process. Diagnosis of acute coagulopathy currently relies on laboratory assessment of clotting times. These tests do not fully characterize the coagulopathy and have significant limitations, which reduce their clinical utility. Summary Acute coagulopathy results in increased transfusion requirements, incidence of organ dysfunction, critical care stay and mortality. Recognition of an early coagulopathic state has implications for the care of shocked patients and the management of massive transfusion. Identification of novel mechanisms for traumatic coagulopathy may lead to new avenues for drug discovery and therapeutic intervention.
引用
收藏
页码:680 / 685
页数:6
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