Coagulation and fibrinolytic responses at an early phase of trauma: The main issues in the world are reviewed and discussed

Abstract

We reviewed the recent advances in the coagulation and fibrinolytic responses in patients at an early phase of trauma. Recently, the Educational Initiative on Critical Bleeding in Trauma (EICBT) proposed new clinical entities,“Coagulopathy of Trauma”and“Acute Coagulopathy of Trauma-Shock (ACoTS) ”. A new clinical entity must be clearly distinguished from other diseases and syndromes using definite diagnostic criteria. However, the EICBT failed to establish diagnostic criteria for these two clinical entities. Increasing clinical evidence suggests that the Coagulopathy of Trauma and ACoTS are equivalent to disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype. Neither the Coagulopathy of Trauma nor ACoTS can be differentially diagnosed from DIC with the fibrinolytic phenotype, thus suggesting that these two concepts are not independent diseases or syndromes but instead are only vague clinical conditions. Misleading terms, such as Coagulopathy of Trauma and ACoTS without a clear definition or diagnostic criteria should not be used for the explanation of changes in coagulation and fibrinolysis in patients at an early phase of trauma. We emphasize that DIC with the fibrinolytic phenotype should be described in the same manner that it has been until recently.