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Invited Critique
August 18, 2008

Trauma and Coagulopathy—Invited Critique

Arch Surg. 2008;143(8):802. doi:10.1001/archsurg.143.8.802

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.