Coagulation Management in Trauma: Do We Need a Viscoelastic Hemostatic Assay?

Purpose of Review Coagulopathy is present in nearly 25% of severely injured patients and increases significantly with administration of massive transfusion of blood products. The cell-based model of hemostasis provides a background on which the current understanding of Acute Traumatic Coagulopathy (ATC) is managed. Recent Findings Viscoelastic Hemostatic Assays (VHAs) generate results that identify severely injured trauma patients at risk for large-volume blood transfusion, coagulation deficiencies, and increased mortality that are available more quickly than Conventional Coagulation Tests (CCTs). Viscoelastic-guided resuscitation during hemorrhage was recently described and demonstrated no difference in 24-h survival and free of massive transfusion. VHAs are potentially valuable in early detection of patients at risk for massive resuscitation and severe coagulopathy. This review will address the ACT, clinical data supporting VHA utilization in trauma patients, and limitations in scientific knowledge of viscoelastic testing.