Anesthesiology and Critical Care Department, Gregorio Marañon Hospital, Madrid, Spain.
Anesthesiology and Critical Care Department, Gregorio Marañon Hospital, Madrid, Spain.
Transfus Med Rev. 2021 Oct;35(4):80-86. doi: 10.1016/j.tmrv.2021.07.004. Epub 2021 Aug 29.
There is no standard definition for trauma-induced coagulopathy (TIC). However, it could be defined as an abnormal hemostatic response secondary to trauma. The terms "early TIC" and "late TIC" have been recently suggested. "Early TIC" would refer to the inability to achieve effective hemostasis exacerbating an uncontrolled bleeding in a shocked patient with ischemia-reperfusion damage (bleeding phenotype) and takes place usually early after injury, whereas "late TIC" would represent a hypercoagulable state after surviving a severe tissue injury, that would contribute to thromboembolic events and multiorgan failure (MOF), (thrombotic phenotype), occurring typically hours after the trauma insult though it could be delayed for days. In addition, severe tissue injury when there is no associated shock could be followed by an early hypercoagulable state, representing an evolutionary maladaptive response of a physiologic mechanism created to increase clot formation and prevent bleeding. Therefore, TIC is not a uniform phenotype, ranging from bleeding to pro-thrombotic profiles. This current concept of TIC is mainly based on the recognition of TIC as a unique clotting disorder following trauma in which alterations in the endothelial function, fibrinolysis regulation and platelet behavior after major trauma are the main cornerstones.
创伤后凝血病（TIC）尚无标准定义。然而，它可以被定义为创伤继发的异常止血反应。最近提出了“早期 TIC”和“晚期 TIC”的概念。“早期 TIC”是指在伴有缺血再灌注损伤（出血表型）的休克患者中，无法实现有效的止血，从而加重失控性出血，通常发生在损伤后早期；而“晚期 TIC”则代表严重组织损伤后出现的高凝状态，会导致血栓栓塞事件和多器官功能衰竭（MOF）（血栓表型），通常发生在创伤后数小时，但也可能延迟数天。此外，在没有相关休克的情况下发生严重组织损伤后，可能会出现早期高凝状态，这代表了一种生理机制的进化适应不良反应，该机制旨在增加血栓形成并防止出血。因此，TIC 不是一种统一的表型，从出血到促血栓形成的表现均有涉及。目前 TIC 的概念主要基于这样一种认识，即 TIC 是创伤后出现的一种独特的凝血障碍，其中内皮功能、纤维蛋白溶解调节和血小板行为的改变是主要基石。
