Shock and Coagulopathy

The care of bleeding trauma patients with associated orthopedic injuries remains challenging. The combination of shock and tissue injury in these severely injured patients results in multiple proinflammatory factors being released and/or produced. Unfortunately, these responses to severe injury lead to excessive inflammation resulting in worse outcomes, including multiple organ failure and death. As our understandings of post-injury physiological responses evolve, we are finding that there are multiple intersections between both the inflammatory and coagulation pathways, which explain the close and frequent association of shock with coagulopathy. However, the current evaluation and diagnosis of coagulopathies, as determined by plasma-based laboratory tests, have been limited in identifying both hypocoagulable and hypercoagulable states in post-injury trauma patients. Consequently, viscoelastic hemostatic assays are now the standard of care in identifying post-injury coagulopathies and have further elucidated links between inflammation and coagulation. Moreover, viscoelastic hemostatic assays may also prove to be the optimal devices to guide component resuscitation. Extensive research in resuscitation and the use of rapid point-of-care assays are necessary to further understand the complex pathophysiological responses to shock, especially in the trauma setting. Earlier, and appropriate, interventions, which minimize inflammation and decrease coagulopathies, may ultimately reduce transfusions and improve outcomes.