How do you approach coagulopathy in a trauma patient?

• A. Consider plasma vs blood products
• B. Start anticoagulants
• C. Use only platelets
• D. Ignore coagulopathy

Answer: (A)

In trauma, coagulopathy is best addressed by quickly replacing lost clotting factors and components with blood products rather than using anticoagulants. Plasma provides essential clotting factors and, when used as part of a balanced resuscitation strategy with red blood cells and platelets, helps restore the blood’s ability to form stable clots. Relying on platelets alone won’t correct deficiencies in clotting factors, and starting anticoagulants would worsen bleeding. Ignoring the coagulopathy allows ongoing hemorrhage and worsened outcomes. In practice, activate a massive transfusion approach and transfuse a balanced mix of plasma, platelets, and red cells (with cryoprecipitate or fibrinogen as needed and antifibrinolytic therapy when appropriate) to stop bleeding and improve survival.