Diagnosis and Treatment of Trauma Induced Coagulopathy (TIC) Using Thromboelastography (TEG)

Trauma induced coagulopathy (TIC) has been recognized as a distinct entity associated with increased mortality, morbidity and transfusion requirements. Uncontrolled bleeding is the most frequent preventable cause of death in trauma patients reaching hospital alive. TIC has been long thought to develop as a result of hemodilution, acidosis and hypothermia often related to resuscitation practices. The lack of well defined diagnosis criteria for TIC impedes early identification and treatment. Most authors established the presence of TIC if Prothombin time (PT) and activated thromboplastin time (APTT) were 1.5 times over the normal value. Mechanisms contributing to TIC include anticoagulation, consumption, platelet dysfunction and hyperfibrinolysis. Thromboelastography (TEG) is a portable bedside device that gives qualitative results for coagulation function, based on clotting, kinetics, strength and lysis. The result is available within 3 - 10 minutes, in the form of curve. Depending on the results of TEG, early administration of tranexamic acid (TXA), recombinant factor VIIa and aggressive blood product transfusional management for TIC with a red blood cell:plasma:platelets ratio close to 1:1:1 could result in decreased mortality from uncontrolled bleeding. This article reviews the pathophysiology and management of TIC.