1. Divergent Patient Populations: Trauma versus Sepsis:

• Trauma and sepsis are both associated with coagulation abnormalities, but the drivers and timing of coagulopathy differ between the two patient populations.
• Trauma-induced coagulopathy (TIC) occurs shortly after injury, while sepsis-induced coagulopathy (SIC) can develop over days or weeks.

1. Origins of Disseminated Intravascular Coagulation (DIC):

• The term DIC was introduced to the literature in reference to coagulation changes observed in hemorrhagic shock.
• Early experiments demonstrated the reversal of DIC-attributable death with heparin and fibrinolytic agents.

1. Identification of Early Trauma-Induced Coagulopathy:

• Early coagulopathy in trauma is driven by shock and tissue injury.
• There is a range of coagulation changes after trauma, from hypocoagulable to hypercoagulable, with varying upregulation and inhibition of coagulation components.
• Assessing coagulation is important for initial prognosis of critically injured patients.

1. Mechanisms of Early Trauma-Induced Coagulopathy:

• Impaired thrombin generation, fibrinogen dysfunction, platelet dysfunction, and alterations of the fibrinolytic system contribute to early TIC.
• The exact mechanisms of each component are not fully understood, but several hypotheses have been generated.

1. Early Adjuncts in Trauma Resuscitation:

• Tranexamic acid, prehospital plasma resuscitation, and viscoelastic hemostatic assays (VHA) have shown positive outcomes in reducing mortality in trauma patients at risk of bleeding.

1. Use of MTPs for early resuscitation:

• Trauma centers use MTPs with an empiric ratio of red blood cell, plasma, and platelets to guide early resuscitation.
• Lower ratios (2:1:1) have comparable outcomes to the standard 1:1:1 ratio.

1. Empiric blood component transfusion:

• Empiric blood component transfusion should start when patients have received more than 4 units of red blood cells.