Updates in the management of severe coagulopathy in trauma patients

Mauricio Lynn, Igor Jeroukhimov, Yoram Klein, Uri Martinowitz

Research output: Contribution to journalReview articlepeer-review

117 Scopus citations

Abstract

Coagulopathy is the major cause of bleeding-related mortality in patients who survive the operating room. Its association with hypothermia and metabolic acidosis is common and constitutes a vicious cycle. Usually, post-traumatic coagulopathy is an early event and may be present during surgery. The pathogenesis of severe post-traumatic coagulopathy is complex and multifactorial. Virtually every aspect of the normal coagulation cascade is affected in the cold, acidotic, exsanguinating trauma patient. In the last decade many surgeons have emphasized the role of prevention or early treatment of this vicious cycle. Damage control surgery with planned re-operations has demonstrated superiority over the traditional approach in cases where the patient's condition is deteriorating. Early control of surgical bleeding and significant contamination, together with vigorous correction of hypothermia and continuous resuscitation, has improved the survival of these patients. Recently, a new adjunct to the treatment of coagulopathy in trauma patients has been reported and is undergoing controlled animal trials. Recombinant activated factor VII (rFVIIa) was originally developed as a pro-hemostatic agent for the treatment of bleeding episodes in hemophilia patients. rFVIIa has been successfully used in moribund trauma patients in whom standard procedures had failed to correct bleeding. Preliminary preclinical and clinical studies are under way.

Original languageEnglish (US)
Pages (from-to)S241-S247
JournalIntensive Care Medicine, Supplement
Volume28
Issue number2
StatePublished - Jan 1 2002

Keywords

  • Coagulopathy
  • Hemorrhage
  • Hypothermia
  • Recombinant activated factor VII (rFVIIa)

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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