Coagulopathy

Coagulopathy may cause uncontrolled internal or external bleeding. Left untreated, uncontrolled bleeding may cause damage to joints, muscles, or internal organs and may be life-threatening. People should seek immediate medical care for serious symptoms, including heavy external bleeding, blood in the urine or stool, double vision, severe head or neck pain, repeated vomiting, difficulty walking, convulsions, or seizures. They should seek prompt medical care if they experience mild but unstoppable external bleeding or joint swelling and stiffness.{{citation needed|date=June 2016}}

The normal clotting process depends on the interplay of various proteins in the blood. Coagulopathy may be caused by reduced levels or absence of blood-clotting proteins, known as clotting factors or coagulation factors. Genetic disorders, such as hemophilia and Von Willebrand disease, can cause a reduction in clotting factors.{{cite journal | vauthors = Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Filipescu D, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Vincent JL, Rossaint R | display-authors = 6 | title = Management of bleeding and coagulopathy following major trauma: an updated European guideline | journal = Critical Care | volume = 17 | issue = 2 | pages = R76 | date = April 2013 | pmid = 23601765 | pmc = 4056078 | doi = 10.1186/cc12685 | doi-access = free }}

Anticoagulants such as warfarin will also prevent clots from forming properly. Coagulopathy may also occur as a result of dysfunction or reduced levels of platelets (small disk-shaped bodies in the bloodstream that aid in the clotting process).

In 2003, Karim Brohi, Professor of Trauma Sciences at Queen Mary University of London, first introduced the term Acute Traumatic Coagulopathy (ATC),{{cite journal | vauthors = Brohi K, Singh J, Heron M, Coats T | title = Acute traumatic coagulopathy | language = English | journal = The Journal of Trauma | volume = 54 | issue = 6 | pages = 1127–1130 | date = June 2003 | pmid = 12813333 | doi = 10.1097/01.TA.0000069184.82147.06 | s2cid = 7583542 | doi-access = free }} establishing that coagulopathy induced by trauma results in:

• more severe bleeding
• multi-organ failure
• high mortality

If someone has coagulopathy, their health care provider may help them manage their symptoms with medications or replacement therapy. In replacement therapy, the reduced or absent clotting factors are replaced with proteins derived from human blood or created in the laboratory. This therapy may be given either to treat bleeding that has already begun or to prevent bleeding from occurring.{{citation needed|date=June 2016}}

One area of treatment is managing people with major bleeding in a critical setting, like an emergency department. In these situations, the common treatment is transfusing a combination of red cells with one of the following options:{{citation needed|date=June 2016}}

• Blood plasma
• Prothrombin complex concentrate, factor XIII, and fibrinogen
• Fibrinogen with tranexamic acid

The use of tranexamic acid is the only option that is currently supported by a large, randomized, controlled clinical trial, and is given to people with major bleeding after trauma.{{cite journal| vauthors = Shakur H, Roberts I, Perel P |title=Tranexamic acid for trauma – Authors' reply|journal=The Lancet|volume=376|issue=9746|year=2010|pages=1050–1051|issn=0140-6736|doi=10.1016/S0140-6736(10)61479-1|s2cid=54321951}} There are several possible risks to treating coagulopathies, such as transfusion-related acute lung injury, acute respiratory distress syndrome, multiple organ dysfunction syndrome, major hemorrhage, and venous thromboembolism.{{cn|date=November 2021}}

• Trauma triad of death
• Hypocoagulability
• Hypercoagulability

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{{Medical resources

| DiseasesDB = 29158

| ICD10 = {{ICD10|D|65||d|65}}-{{ICD10|D|68||d|65}}

| ICD9 = {{ICD9|286}}

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{{Diseases of megakaryocytes|us=y}}

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Category:Bleeding

Category:Coagulopathies