When I first started reading “Trauma and Coagulopathy: A New Paradigm to Consider” by MacLeod, I was skeptical. I liked the “old” paradigm. Most trauma surgeons accept the theory that trauma-associated coagulopathy is a secondary phenomenon. Bleeding leads to coagulopathy, hypothermia, and acidosis, which make up the “lethal triad.” As each of these 3 components worsens after major trauma, they exacerbate one another and patients begin a downward spiral known as the “bloody vicious cycle.” The concept of abbreviated “damage-control” surgery to stop this sequence before irreversible physiologic exhaustion is the current tactic in cases of exsanguinating trauma. This approach makes intuitive sense and has been a way of life for my entire surgical career. It is a framework to educate fellows, residents, students, and staff in the clinical treatment of severely injured patients at trauma centers across around the world.
Haut ER. Trauma and Coagulopathy—Invited Critique. Arch Surg. 2008;143(8):802. doi:10.1001/archsurg.143.8.802