Abstract
Trauma is one of the leading causes of mortality in the world, accounting for millions
of deaths per year. One of the most frequent causes of death in trauma patients is
hemorrhage. The presence of a coagulopathy in trauma patients more than doubles the
expected mortality. Coagulation management is a key aspect of care for bleeding trauma
patients and has been investigated in many studies. However, it is unclear whether
a particular approach to coagulation management is associated with a reduction in
mortality. Treatment may be guided (e.g., viscoelastic test-guided administration
of coagulation factor concentrates) or nonguided (e.g., treatment with a fixed ratio
of plasma:red blood cells). This review aimed to assess the published literature regarding
coagulation management technique and mortality rate. From the 41 articles obtained
in the literature search, there appeared to be a trend toward lower mortality in studies
utilizing a guided approach, despite a higher injury severity score in these patients.
There were many methodological variations across studies including coagulation management
approaches, inclusion criteria, time and type of measurements, use of early fast coagulation
monitoring and damage control surgery principles, additional products to those under
study, and potential regional differences. It is essential that controlled trials
are performed to ascertain optimal transfusion approaches in trauma patients.
Keywords
trauma - coagulation - hemostasis - mortality - transfusion
