Trauma is very demanding for the hemostatic system. Hemorrhage is the most immediate and life-threatening hemostatic defect in a majority of trauma patients. Hemorrhage-induced coagulopathy should not be seen as resulting simply from dilution of hemostatic factors by massive blood transfusions. The contribution of disseminated intravascular coagulation to coagulopathy should be recognized. Inasmuch as possible, the conditions leading to disseminated intravascular coagulation should be treated aggressively.
After the initial, hemorrhagic phase of the hemostatic disturbance is controlled, clinicians should rapidly focus on prevention of the more insidious venous thrombotic complications responsible for significant morbidity and mortality in this patient population. Diagnosis of these complications is difficult and may require serial diagnostic procedures. A multimodal approach to the prevention of venous thrombotic complications is described, combining mechanical and pharmacologic interventions. Unfortunately, the incidence of such thrombotic complications remains high and further studies will be required to optimize prophylaxis.
*Montreal Heart Institute, Canada; †Groupe hospitalier Cochin, Paris, France; ‡Hôpitaux Universitaires de Genève, Suisse; §Hôpital Avicenne, Bobigny, France; ∥Montreal Heart Institute, Canada; for the Groupe d’Intérêt en Hémostase Périopératoire
Correspondence to Jean-François Hardy, MD, Montreal Heart Institute, 5000 Bélanger est, Montréal (Qc), Canada, H1T 1C8; e-mail: firstname.lastname@example.org