From molecular networks to precision therapeutics: the evolving landscape of trauma-induced coagulopathy.

BACKGROUND

Trauma-induced coagulopathy (TIC) affects approximately one quarter of severely injured patients and is linked to markedly increased mortality. Despite improvements in trauma care, understanding of TIC mechanisms and development of targeted treatment strategies remain limited. This review summarizes recent advances in mechanistic studies and translational research that inform targeted approaches for TIC.

METHODS

A systematic PubMed search identified English-language basic research on TIC published from January 2016 to July 2025. The review focused on studies utilizing established animal models and experimental systems to explore disease mechanisms, intervention strategies, and translational relevance. Included studies were assessed for scientific rigor, clinical significance, and contributions to advancing TIC knowledge.

RESULTS

Recent research clarifies the contributions of endothelial glycocalyx shedding, platelet dysfunction, and imbalanced coagulation and fibrinolysis to TIC development. Inflammatory processes and immunothrombosis further disrupt hemostasis. Animal studies in a variety of species have improved understanding of the roles of tissue injury, shock, biological sex, comorbidities, and environmental influences. Preclinical progress includes innovations in fluid resuscitation, precise blood component therapy, targeted antifibrinolytics, vasoactive medications, and cellular therapies. Novel diagnostic tools featuring viscoelastic assays and new biomarkers offer promise for earlier detection and better classification of TIC subtypes. However, challenges persist related to species-specific responses, optimal timing of interventions, and individualized treatment.

CONCLUSION

Integrating mechanistic and translational research is transforming the concept of TIC into a dynamic, heterogeneous syndrome that requires individualized therapies. Advances in diagnostics and precision interventions will play a critical role in improving global outcomes for trauma patients with TIC.