ICU SAQs · Resuscitation
Trauma coagulopathy, DIC and the tranexamic acid clock
A CICM SAQ on DIC in trauma — the 2025 ISTH score, the haemorrhagic phenotype, transfusion for bleeding, and the evidence and timing for tranexamic acid.
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Prompt
A 34-year-old is brought in 2 hours after a high-speed crash with pelvic and femoral fractures, BP 82/50 and ongoing bleeding. Platelets 70 x10^9/L, PT prolonged by 5 seconds, fibrinogen 0.8 g/L, D-dimer more than 7 times the upper normal limit. Discuss the coagulopathy and its management.
Question
A 34-year-old is brought in 2 hours after a high-speed crash with pelvic and femoral fractures, BP 82/50 and ongoing bleeding. Platelets 70 ×10^9/L, PT prolonged by 5 seconds, fibrinogen 0.8 g/L, D-dimer more than 7 times the upper normal limit. Discuss the coagulopathy and its management.[1]
References5ShowHide
- [1]Iba T, Levy JH, Maier CL, et al. Updated definition and scoring of disseminated intravascular coagulation in 2025: communication from the ISTH SSC Subcommittee on Disseminated Intravascular Coagulation. Journal of thrombosis and haemostasis : JTH, 2025.PMID 40216223
- [2]Wada H, Thachil J, Di Nisio M, et al. Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines. Journal of thrombosis and haemostasis : JTH, 2013.PMID 23379279
- [3]Levi M, Toh CH, Thachil J, et al. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. British journal of haematology, 2009.PMID 19222477
- [4]CRASH-2 trial collaborators, Shakur H, Roberts I, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet (London, England), 2010.PMID 20554319
- [5]CRASH-2 collaborators, Roberts I, Shakur H, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet (London, England), 2011.PMID 21439633