Coagulation defects in trauma patients: etiology, recognition, and therapy
Section snippets
Etiology
The coagulation defects that occur in trauma patients are complex in origin (Box 1). Often, these abnormalities are caused by many interrelated factors. The most common reasons for abnormal coagulation laboratory test results in these patients are dilution of hemostatic factors by fluid or blood resuscitation, severe hypothermia, tissue damage from trauma, and effects of underlying diseases.
Recognition
Patients who bleed from coagulation defects have generalized bleeding from multiple sites. These patients have diffuse oozing in the surgical field, bleeding from intravenous (IV) sites, and ongoing blood loss into drains. A bleeding diathesis is confirmed by laboratory testing, but in emergency situations, therapy should be given while awaiting the results of testing.
Therapy
Therapy of the bleeding trauma patient is directed at correcting the coagulation defects, treatment of related problems such as underlying coagulation defects, and therapy of complications such as hypothermia.
Summary
Trauma patients have many reasons to have defects in coagulation. These can be caused by the trauma or because of pre-existing disorders. Trauma patients who are at risk for coagulation defects should be screened with the basic tests (aPTT, INR/PT, platelet counts, hematocrit, and fibrinogen), with therapy based on the results. Attention also should be paid to any other correctable factors such as hypothermia. Finally, pre-existing disorders can influence the patient's hemostasis greatly and
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