ICU · Haematology / trauma

Massive Transfusion & Trauma Coagulopathy — The Lethal Triad, TXA & 1:1:1

Also known as Massive transfusion · MTP · Trauma coagulopathy · Acute traumatic coagulopathy · ATC · Lethal triad · Tranexamic acid · TXA · CRASH-2 · PROPPR · Hyperfibrinolysis · TEG · ROTEM

The trauma coagulopathy has the two components: the acute traumatic coagulopathy (ATC — the early, the injury-driven, the protein-C activation, the hyperfibrinolysis) and the dilutional coagulopathy (the massive RBC without the factors or the platelets). The lethal triad — the acidosis (the clotting-factor dysfunction), the hypothermia (the platelet and the enzyme dysfunction), and the coagulopathy — the vicious the cycle. The massive transfusion protocol (MTP) — the 1 to 1 to 1 (RBC to the plasma to the platelets), PROPPR no mortality difference but the fewer the exsanguination. The tranexamic acid (TXA) — the CRASH-2, the 1 g plus the 1 g within 3 h (the beyond the 3 h the harmful). The calcium (the citrate the chelation — the under 0.90 the severe, the double the mortality). The fibrinogen (the first the factor to the fall — the under 1.5 g per L the treat). The viscoelastic (the TEG the ROTEM — the LY30 the hyperfibrinolysis, the FIBTEM the fibrinogen).

Checked against its sources on 2 Sept 2026