Traumatic disseminated intravascular coagulation: a narrative review of modern concepts in pathophysiology, diagnosis, and management.

Traumatic disseminated intravascular coagulation is a catastrophic complication in severely injured patients, profoundly impacting morbidity and mortality. This condition manifests as a dynamic, heterogeneous spectrum: an initial hyperfibrinolytic phenotype followed by a thrombotic phenotype characterized by microvascular thrombosis and organ dysfunction. Recent advances frame traumatic disseminated intravascular coagulation as a failure of immunothrombosis, driven by damage-associated molecular patterns, neutrophil extracellular traps, and catastrophic endotheliopathy. This narrative review synthesized modern pathophysiological concepts (eg, shock-induced endotheliopathy, antithrombin leakage, and traumatic brain injury-specific triggers) with evolving clinical strategies. We compared diagnostic scoring systems (eg, Japanese Association for Acute Medicine) and highlighted the pivotal role of viscoelastic testing in guiding resuscitation. Management principles are detailed as a phased approach: (1) early, viscoelastic testing-guided damage control resuscitation and tranexamic acid for hemorrhage and (2) late-phase viscoelastic testing prophylaxis and targeted, albeit controversial, anticoagulant use to manage thrombosis. The aim was to provide clinicians with an evidence-based framework for the early recognition and effective management of this complex syndrome.