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Review
. 2017 Jan 31:5:14.
doi: 10.1186/s40560-016-0200-1. eCollection 2017.

Pathophysiology of trauma-induced coagulopathy: disseminated intravascular coagulation with the fibrinolytic phenotype

Mineji Hayakawa  1
Affiliations
Review

Pathophysiology of trauma-induced coagulopathy: disseminated intravascular coagulation with the fibrinolytic phenotype

Mineji Hayakawa. J Intensive Care. .

Abstract

In severe trauma patients, coagulopathy is frequently observed in the acute phase of trauma. Trauma-induced coagulopathy is coagulopathy caused by the trauma itself. The pathophysiology of trauma-induced coagulopathy consists of coagulation activation, hyperfibrino(geno)lysis, and consumption coagulopathy. These pathophysiological mechanisms are the characteristics to DIC with the fibrinolytic phenotype.

Keywords: Coagulopathy; Disseminated intravascular coagulation; Fibrinogen; Fibrinolysis; Massive bleeding; Transfusion; Trauma.

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Figures

Fig. 1
Fig. 1
Trauma-associated coagulopathy and trauma-induced coagulopathy. Trauma-associated coagulopathy is caused by multiple factors and includes trauma-induced coagulopathy, which is caused by trauma itself.
Fig. 2
Fig. 2
Spontaneous thrombin generation in severe trauma. a Stimulated thrombin generation curve. Although the amount of thrombin generation was lower in the Trauma group than the control group, time to initiation of thrombin generation and time to peak thrombin generation were shorter in the trauma group than the control group, suggesting coagulation activation. b Non-stimulated thrombin generation curve. Spontaneous thrombin generation was observed in the trauma group but not in the control group, demonstrating the presence of circulating procoagulants in the systemic circulation of the trauma group. Blue line: control group; red line: trauma group. (Cited as Figure 5 in our previous manuscript [27] and adapted with permission from Wolters Kluwer Health, Inc.)
Fig. 3
Fig. 3
Correlations between antithrombin activity and generated thrombin. Antithrombin was significantly negatively correlated with the ratio of the peak thrombin generation level to the factor II activity (ρ = −0.733, P < 0.001). Peak height/factor II ratio, peak thrombin generation level/factor II activity. a Antithrombin was significantly negatively correlated with the ratio of the generated thrombin amount to the factor II activity (ρ = −0.839, P < 0.001). ETP/factor II ratio, generated thrombin amount/factor II activity. (Cited as Figure 4 in our previous manuscript [27] and adapted with permission from Wolters Kluwer Health, Inc.)
See this image and copyright information in PMC

References

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