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Trauma Induced Coagulopathy pp 195–217Cite as

Disseminated Intravascular Coagulation

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Abstract

Following trauma, local hemostasis and thrombosis act to induce physiological wound healing and innate immune responses, respectively, to impede the dissemination of damage-associated molecular patterns (DAMPs) into the systemic circulation. However, if overwhelmed by systemic inflammation caused by extensive tissue damage and tissue hypoperfusion, both of these processes cause pathologic changes, which manifest as systemic disseminated intravascular coagulation (DIC). High levels of DAMPs and inflammatory cytokines activate both extrinsic and intrinsic coagulation pathways. Impaired anticoagulation pathways induce insufficient control of coagulation, leading to systemic thrombin generation and ultimately consumption coagulopathy. Fibrin(ogen)olysis due to tissue-type plasminogen activator is highly active in the early phase of trauma due to endothelial hypoperfusion and hypoxia in DIC with the fibrinolytic phenotype, contributing to the oozing-type coagulopathic bleeding. Persistently high levels of plasminogen activator inhibitor-1 expressed in the endothelium change DIC with the fibrinolytic phenotype into the thrombotic phenotype, which is followed by microvascular thrombosis and then multiple organ dysfunction syndrome. Microvascular thrombosis has been observed in both types of DIC, but especially in the fibrinolytic phenotype, where it can be exacerbated by antifibrinolytic therapy. DIC should be diagnosed by DIC scoring systems, and key to managing DIC is treating the trauma itself and hemorrhagic shock. The mechanisms of hemostatic changes in trauma are multifactorial; the coexistence of hypothermia, acidosis, and dilution aggravate DIC and lead to so-called trauma induced coagulopathy.

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Authors and Affiliations

  1. Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N17W5, Kita-Ku, Sapporo, 060-8638, Japan

    Satoshi Gando M.D.

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  1. Dept of Surgery & Trauma Research Center, Univ of Colorado School of Medicine, Aurora, Colorado, USA

    Eduardo Gonzalez

  2. Dept of Surgery & Trauma Research Center, Univ of Colorado School of Medicine, Aurora, Colorado, USA

    Hunter B. Moore

  3. Dept of Surgery & Trauma Research Center, Univ of Colorado Sch of Med&Denver Healt, Denver, Colorado, USA

    Ernest E. Moore

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Gando, S. (2016). Disseminated Intravascular Coagulation. In: Gonzalez, E., Moore, H., Moore, E. (eds) Trauma Induced Coagulopathy. Springer, Cham. https://doi.org/10.1007/978-3-319-28308-1_13

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