Acute traumatic coagulopathy: The elephant in a room of blind scientists

Michael A. Meledeo, Maryanne C. Herzig, James A. Bynum, Xiaowu Wu, Anand K. Ramasubramanian, Daniel N. Darlington, Kristin M. Reddoch, Andrew P. Cap

Research output: Contribution to journalArticle

Abstract

Acute traumatic coagulopathy (ATC) is the failure of coagulation homeostasis that can rapidly arise following traumatic injury, hemorrhage, and shock; it is associated with higher injury severity, coagulation abnormalities, and increased blood transfusions. ATC has historically been defined by a prolonged prothrombin time (PT), although newer, more informative measurements of hemostatic function have been employed to improve diagnosis and support clinical decision making. The underlying biochemical mechanisms of and best practice therapeutics for ATC remain under active investigation because of its significant correlation to poor outcomes.The wide range of hypothesized mechanisms for ATC results from the large number of symptoms, phenotypes, and altered states in these patients as observed by multiple research groups. Much like the ancient fable of blind men describing an elephant from their limited perspectives, the limited nature of clinical and laboratory tools used to diagnose coagulopathy or evaluate hemostatic function have made finding causation difficult. The prolonged PT, degree of fibrinolysis, depletion of coagulation factors and inhibitors, and general failure of the blood have all been identified as being primary indicators for ATC. Therapeutic interventions including recombinant coagulation factors, anti-fibrinolytics, and blood products have been used with varying degrees of success as they are employed to address specific symptoms.To truly understand the causes of ATC, research efforts must recognize the complexity of the hemostatic system and get to the heart of the matter by answering the question, “Is ATC a pathological condition that develops from the observed deficiencies in coagulation, fibrinolysis, and autoregulation, or is ATC an adaptive response generated as the body attempts to restore perfusion and avoid massive organ failure?” Since patient management must proceed without definitive answers regarding the entire causative chain, the current therapeutic focus should be on using what knowledge has been gained to the patient’s advantage: control hemorrhage, maintain appropriate homeostatic balances of coagulation proteins, and restore oxygen perfusion.

Original languageEnglish (US)
JournalJournal of Trauma and Acute Care Surgery
DOIs
StateAccepted/In press - Mar 22 2017

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Hemostatics
Blood Coagulation Factors
Prothrombin Time
Fibrinolysis
Homeostasis
Hemorrhage
Wounds and Injuries
Practice Guidelines
Blood Transfusion
Causality
Decision Making
Oxygen
Phenotype
Proteins

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Meledeo, M. A., Herzig, M. C., Bynum, J. A., Wu, X., Ramasubramanian, A. K., Darlington, D. N., ... Cap, A. P. (2017). Acute traumatic coagulopathy: The elephant in a room of blind scientists. Journal of Trauma and Acute Care Surgery. DOI: 10.1097/TA.0000000000001431

Acute traumatic coagulopathy : The elephant in a room of blind scientists. / Meledeo, Michael A.; Herzig, Maryanne C.; Bynum, James A.; Wu, Xiaowu; Ramasubramanian, Anand K.; Darlington, Daniel N.; Reddoch, Kristin M.; Cap, Andrew P.

In: Journal of Trauma and Acute Care Surgery, 22.03.2017.

Research output: Contribution to journalArticle

Meledeo, MA, Herzig, MC, Bynum, JA, Wu, X, Ramasubramanian, AK, Darlington, DN, Reddoch, KM & Cap, AP 2017, 'Acute traumatic coagulopathy: The elephant in a room of blind scientists' Journal of Trauma and Acute Care Surgery. DOI: 10.1097/TA.0000000000001431
Meledeo MA, Herzig MC, Bynum JA, Wu X, Ramasubramanian AK, Darlington DN et al. Acute traumatic coagulopathy: The elephant in a room of blind scientists. Journal of Trauma and Acute Care Surgery. 2017 Mar 22. Available from, DOI: 10.1097/TA.0000000000001431

Meledeo, Michael A.; Herzig, Maryanne C.; Bynum, James A.; Wu, Xiaowu; Ramasubramanian, Anand K.; Darlington, Daniel N.; Reddoch, Kristin M.; Cap, Andrew P. / Acute traumatic coagulopathy : The elephant in a room of blind scientists.

In: Journal of Trauma and Acute Care Surgery, 22.03.2017.

Research output: Contribution to journalArticle

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