Abstract

JIMENEZ B, Juan Carlos; DE LA PENA L, Jairo; TEHERAN M, Rubén  and  OROZCO, Andrés. Early Coagulopathy in Trauma: Do Coagulopathic Patients Reach the Operating Room?. Rev. colomb. anestesiol. [online]. 2010, vol.38, n.4, pp.510-525. ISSN 0120-3347.

Introduction. Acute coagulopathy in trauma results in multiple complications such as the need for blood products, higher rates of organ dysfunction, longer stay in the ICU and higher mortality. With the current knowledge of the pathophysiology of trauma and of the cellular coagulation pathway it is now possible to improve diagnosis and treatment of the initial coagulopathy and achieve better outcomes in our trauma centers. Methods. This paper looks into the basic physiology of coagulation, and the etiology, diagnosis and treatment of early coagulopathy in trauma. The search was done using Mesh and non-Mesh terms with AND connectors: Anesthesia-coagulopathy, postinjury and trauma thromboelastography, transfusion and trauma, shock-Mechanism and trauma review. Results. Acute or early coagulopathy in trauma is directly associated with a state of shock and is characterized by anticoagulation and systemic hyperfibrinolysis; protein C is known to be implicated in this process. It has also been determined that six multi-factorial pathophysiological mechanisms may perpetuate coagulopathy in trauma patients, namely, inflammation, acidosis, hypothermia, shock, tissue trauma and hemodilution. Diagnosis is made using the different tests (PT, PPT, platelets) that have been in use for a long time; however, these tests have drawbacks that limit their clinical usefulness. Thromboelastography can now help guide early transfusion using the best proportion of red blood cells, plasma and platelets on the basis of the best available evidence. Conclusions. We have some knowledge about the pathophysiology coagulopathy associated with trauma but more research in this field is needed. Rapid diagnosis and immediate intervention are important to improve the outcomes with our patients.

Keywords : Coagulopathy; trauma; hemorrhage; transfusion; thromboelastography.

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