Acute Coagulopathy of Trauma-Shock
Acute coagulopathy of trauma-shock (ACoTS) occurs in 25 % of severe trauma patients, and the mortality is fourfold higher than the patients without coagulopathy. Pathophysiology of this complex phenomenon has been emphasized in recent years. Tissue injury
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Abstract Acute coagulopathy of trauma-shock (ACoTS) occurs in 25 % of severe trauma patients, and the mortality is fourfold higher than the patients without coagulopathy. Pathophysiology of this complex phenomenon has been emphasized in recent years. Tissue injury, tissue hypoperfusion, activated protein C and the complements play important roles in the early phase after trauma. The use of blood products, hypothermia, acidosis and inflammation are the main mechanism in late stage. Supplementation of coagulation factors and platelets is not effective. Positive resuscitation and improvement of tissue perfusion may be beneficial. Keywords Acute coagulopathy
Trauma Shock
Trauma is a leading cause of death in modern society. Trauma mostly occurs in young adults and has a big influence on labor force and social stability for its high mortality and disability. Thus, trauma is called “disease of developed society” [1]. Despite great progress in trauma surgery and intensive care in recent years, mortality and disability of severe trauma remains high. Recent studies showed that 25 % of patients with severe trauma developed coagulopathy in the early phase after trauma, and the mortality in those patients was fourfold higher than patients without coagulopathy [2–4]. Acute coagulopathy after trauma is gradually becoming a hotspot in clinical and laboratory research [5]. It is usually called “acute traumatic coagulopathy” [6], “early coagulopathy of trauma” [7], or “trauma-induced coagulopathy” [8]. Hess and colleagues [9] named it acute coagulopathy of trauma-shock (ACoTS) in 2008. ACoTS is
B. Li Jinling Hospital, Research Institute of General Surgery, Nanjing University Medical School, Nanjing 210002, China H. Sun (&) Jinling Hospital, Research Institute of Neurosurgery, Nanjing University Medical School, Nanjing 210002, China e-mail: [email protected] © Springer Nature Singapore Pte Ltd. 2017 X. Fu and L. Liu (eds.), Advanced Trauma and Surgery, DOI 10.1007/978-981-10-2425-2_9
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widely accepted because it reflects the nature of the responsible underlying processes and pathophysiology of this complicated phenomenon. Here, we focus on the progress of research on ACoTS in recent years, especially on its mechanism.
1 Mechanism in the Early Stage 1.1
Tissue Injury and Hypoperfusion
Loss of clotting factors caused by bleeding and consumption in thrombosis, dilution of clotting factors for massive transfusion, and effects of acidosis and hypothermia on coagulation function are considered the main mechanism for coagulopathy in trauma patients in the early phase. This coagulation disorder is described as systemic acquired coagulopathy (SAC) [10]. Recent studies found that the exact mechanism may be not like that. Brohi and MacLeod et al. found that 25 % of patients with severe trauma developed acute traumatic coagulopathy before arriving at emergency room. These patients always did not present with acidosis and hypothermia. Acute coagulopathy could only be detected in trauma patients with tiss
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