Figure 1.

Recently proposed mechanism for coagulopathy in trauma. Tissue trauma activates the coagulation process via tissue factor (TF) and activated factor VII (FVIIa), formerly named the extrinsic pathway, to stop bleeding. Concomitantly, endothelial damage/ischaemia leads to release of physiologic anticoagulants and antifibrinolytics (that is, thrombomodulin (TM), protein C and tissue plasminogen activator (tPA)) due to inflammation and tissue hypoperfusion, to prevent thrombosis. Early coagulopathy develops when there is an imbalance in this process, with excessive anticoagulation, hyperfibrinolysis and consumption of clotting factors. Resuscitation with crystalloid and red blood cells (RBC) can cause/worsen dilution, acidosis and hypothermia. PAI-1, plasminogen activator inhibitor 1.