Pathophysiology of Trauma-Induced Coagulopathy (TIC) and Corresponding Triggers of Thromboelastometry and Whole-Blood Impedance Aggregometry
Pathophysiology of Trauma-Induced Coagulopathy (TIC) and Corresponding Triggers of Thromboelastometry and Whole-Blood Impedance Aggregometry - Flowchart Pathophysiology of Trauma-Induced Coagulopathy (TIC) and Corresponding Triggers of Thromboelastometry and Whole-Blood Impedance Aggregometry Pathophysiology of Trauma-Induced Coagulopathy (TIC) and Corresponding Triggers of Thromboelastometry and Whole-Blood Impedance Aggregometry
«Flowchart»

Trauma

Trauma

Trauma

Trauma

Predisposition (genetics, comorbidities, medications)

Predisposition (genetics, comorbidities, medications)

Predisposition

Tissue injury

Tissue injury

Tissue injury

Loss of coagulation factors (fibrinogen) ↓

Loss of coagulation factors (fibrinogen) ↓

↓ Loss of coagulation factors (fibrinogen) ↓ ↓

Hemorrhage

Hemorrhage

Hemorrhage Hemorrhage

Trauma-induced coagulopathy (TIC) or Acute coagulopathy of trauma shock (ACoTS)

Trauma-induced coagulopathy (TIC) or Acute coagulopathy of trauma shock (ACoTS)

Trauma-induced coagulopathy (TIC) or Acute coagulopathy of trauma shock (ACoTS)

Trauma-induced coagulopathy (TIC) or Acute coagulopathy of trauma shock (ACoTS)

Glycocalyx shedding

Glycocalyx shedding

Glycocalyx shedding

Hemorrhage

Hemorrhage

Hemorrhage

Hemorrhage

Impaired thrombin gen. (INR >1.5 or CTEX >80s)

Impaired thrombin gen. (INR >1.5 or CTEX >80s)

Impaired thrombin gen. (INR >1.5 or CTEX >80s)

EX

Early platelet dysfunction (AUCADP ↓)

Early platelet dysfunction (AUCADP ↓)

Early platelet dysfunction (AUCADP ↓)

ADP ↓

Impaired thrombin gen. (INR >1.5 or CTEX >80s)

Impaired thrombin gen. (INR >1.5 or CTEX >80s)

EX Impaired thrombin gen.

Fibrinogen deficiency (A10FIB <8mm)

Fibrinogen deficiency (A10FIB <8mm)

FIB Fibrinogen deficiency

Loss of coagulation factors (fibrinogen) ↓

Loss of coagulation factors (fibrinogen) ↓

↓ Loss of coagulation factors

Hemodilution

Hemodilution

Hemodilution

Endogenous anticoagulation (CTHEP <CTIN)

Endogenous anticoagulation (CTHEP <CTIN)

Endogenous anticoagulation (CTHEP <CTIN)

HEP IN

Fibrinogen deficiency (A10FIB <8mm)

Fibrinogen deficiency (A10FIB <8mm)

FIB Fibrinogen deficiency

Hypocoagulability (A10EX !!lteq!!45mm)

Hypocoagulability (A10EX !!lteq!!45mm)

EX Hypocoagulability

Volume replacement

Volume replacement

Volume replacement

Shock

Shock

Shock Shock

Cleavage of Va and VIIIa

Cleavage of Va and VIIIa

Cleavage of Va and VIIIa

PAI-1 ↓

PAI-1 ↓

↓ PAI-1 ↓ ↓

Primary hyperfibrinolysis (ML ≥3%)

Primary hyperfibrinolysis (ML ≥3%)

Primary hyperfibrinolysis (ML ≥3%)

≥

Inflammation (prostaglandins, cytokines)

Inflammation (prostaglandins, cytokines)

Inflammation

Consumption of coagulation factors (Fibrinogen) ↓

Consumption of coagulation factors (Fibrinogen) ↓

↓ Consumption of coagulation factors (Fibrinogen) ↓ ↓

Hypothermia

Hypothermia

Hypothermia

Trauma-induced coagulopathy (TIC) or Acute coagulopathy of trauma shock (ACoTS)

Trauma-induced coagulopathy (TIC) or Acute coagulopathy of trauma shock (ACoTS)

Trauma-induced coagulopathy (TIC) or Acute coagulopathy of trauma shock (ACoTS) Trauma-induced coagulopathy (TIC) or Acute coagulopathy of trauma shock (ACoTS)

Hypoperfusion

Hypoperfusion

Hypoperfusion

Acidosis

Acidosis

Acidosis

Glycocalyx shedding

Glycocalyx shedding

Glycocalyx shedding

Synthesis of coagulation factors (Fibrinogen) ↓

Synthesis of coagulation factors (Fibrinogen) ↓

↓ Synthesis of coagulation factors (Fibrinogen) ↓ ↓

Protein C activation

Protein C activation

Protein C activation