The pathophysiology, diagnosis and treatment of the acute coagulopathy of trauma and shock: a literature review.
Background: The acute coagulopathy of trauma and shock is associated with significant mortality and, currently, there are no validated laboratory tests which allow for a rapid recognition and treatment of this condition. Therefore, early detection of any clot abnormality in trauma could improve the...
| Publicado en: | European Journal of Trauma & Emergency Surgery Vol. 41; no. 3; pp. 259 - 273 |
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| Autores principales: | , , , |
| Formato: | review tables/charts Journal Article |
| Publicado: |
Springer Nature
Jun2015
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=109792555&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 109792555 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 18639933 3C05 jtl: European Journal of Trauma & Emergency Surgery issn: 18639933 maglogo: N pubinfo: dt: Jun2015 vid: 41 iid: 3 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 109792555 103029550 10.1007/s00068-013-0360-9 109792555 ppf: 259 ppct: 14 formats: fmt: @attributes: type: P tig: atl: The pathophysiology, diagnosis and treatment of the acute coagulopathy of trauma and shock: a literature review. aug: au: Kaczynski, J. Wilczynska, M. Fligelstone, L. Hilton, J. affil: General and Vascular Surgery Departments, Regional Trauma Centre, Morriston Hospital, ABM University Health Board, Swansea SA6 6NL UK sug: subj: Blood Coagulation Disorders Trauma Shock Blood Coagulation Disorders Physiopathology Blood Coagulation Disorders Diagnosis Blood Coagulation Disorders Therapy Blood Coagulation Disorders Mortality Blood Coagulation Disorders Complications Diagnosis, Laboratory Thrombosis Physiopathology Blood Component Transfusion Blood Coagulation Factors Fibrinogen Tranexamic Acid ab: Background: The acute coagulopathy of trauma and shock is associated with significant mortality and, currently, there are no validated laboratory tests which allow for a rapid recognition and treatment of this condition. Therefore, early detection of any clot abnormality in trauma could improve the diagnosis of trauma-associated coagulopathy and subsequent interventions. Methods: Review of the literature. Results: The standard laboratory tests, including prothrombin time and activated partial thromboplastin time, are unreliable and describe only an isolated fragment of the complex coagulation pathways. Additionally, thromboelastography and thromboelastometry operate in a non-linear regime which implies that clot formation is the product of both the clotting process and the effect of the measurement. The assessment of the clot microstructure using a scanning electron microscope has resulted in a subjective analysis of a clot structure, showing also poor correlation between the coagulation pathways and clot development. The fractal dimension provides information on the structure and quality of the initial clot, which subsequently acts as a template for how the mature clot will behave. However, these data require further verification in an in vivo setting. At present, the treatment of the coagulopathy is delivered by empirically administered massive transfusion protocols, which lack a specific target for replacement therapy. Conclusions: There is enough evidence to demonstrate that we urgently need a robust test, which would determine and quantify both the rate and the extent of coagulation abnormalities. This could help to tailor the treatment of coagulopathy according to the patient's needs. pubtype: Academic Journal doctype: review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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