International Journal of Molecular Medical Science, 2025, Vol.15, No.4, 195-204 http://medscipublisher.com/index.php/ijmms 196 2 Pathophysiology and Coagulation Mechanism of Multiple Trauma 2.1 Systemic effects of multiple traumas Multiple traumas can trigger obvious systemic reactions, affecting almost every organ system. The initial damage can lead to a series of inflammatory, neurological and endocrine, and metabolic changes, which in turn trigger systemic inflammatory response syndrome (SIRS), immune dysfunction and multiple organ failure (Kushimoto et al., 2017). Insufficient blood supply, hypoxia and the release of substances such as cytokines can aggravate these systemic effects, further disrupt the normal balance of the body and increase the risk of complications such as infection and abnormal organ function (Cap and Hunt, 2015; Moore et al., 2021). In addition to direct tissue damage, trauma can also lead to hypothermia, acidosis and blood dilution, which are known as the "three lethal factors" and further disrupt the stable state of the body (Below, 2005; Huang et al., 2024). These factors not only deteriorate the overall condition of the patient, but also play a key role in the development of abnormal coagulation function. Therefore, early detection and treatment of these problems are crucial for helping patients recover better (Cap and Hunt, 2015; Moore et al., 2021). 2.2 Pathogenesis of traumatic coagulopathy (TIC) Traumatic coagulation disorder (TIC) is a complex process caused by multiple factors and develops rapidly after injury. The early stage of the disease is characterized by weakened coagulation ability, mainly due to the interaction of tissue damage and shock, which leads to problems in endothelial activation, immune response, and the functions of platelets and coagulation factors (Moore et al., 2021). The main reasons include activation of the protein C pathway, rapid fibrinolysis, endothelin shedding, and impaired platelet function, all of which may lead to insufficient clot formation and increase the risk of bleeding (Davenport, 2013; Cardenas et al., 2014; Davenport and Brohi, 2016; Buzzard and Schreiber, 2023). With the development of TIC, patients may enter a state of excessive coagulation function, increasing the risk of venous thromboembolism and organ failure. The dynamic mutual influence of the action pathways of procoagulant substances and anticoagulant substances, coupled with the effects of resuscitation measures (such as intravenous infusion and blood transfusion), will make the clinical situation more complicated. Laboratory test results often show excessive fibrinogen consumption, abnormal thrombin production and fibrinolysis dysfunction, but these results are not always related to the actual bleeding situation, which also highlights the difficulty of diagnosing TIC (Cardenas et al., 2014; Chang et al., 2016; Moore et al., 2021). 2.3 The relationship between post-traumatic bleeding and coagulation dysfunction Post-traumatic bleeding is both a cause and a result of coagulation dysfunction. Severe bleeding can lead to the consumption and dilution of coagulation factors and platelets, while continuous blood loss can aggravate hypothermia and acidosis, further damaging coagulation function (Below, 2005). If this situation is not prevented in time, it will quickly fall into a vicious cycle of blood loss. Therefore, controlling bleeding and correcting coagulation function as early as possible are key focuses in trauma care (Grottke et al., 2007; Cap and Hunt, 2015; Moore et al., 2021). The relationship between bleeding and coagulation disorders is mutual: traumatic coagulation dysfunction increases the risk of uncontrolled bleeding, and persistent bleeding, due to the continuous loss and dilution of hemostatic substances, makes coagulation dysfunction more severe. This mutual influence indicates that early hemostatic intervention measures and targeted coagulation monitoring are of great significance in breaking this vicious cycle and improving the survival rate of patients with multiple trauma (Below, 2005; Grottke et al., 2007; Liu and Tian, 2016; Moore et al., 2021). 3 Key Measures for Early Hemostasis Care 3.1 Preliminary assessment and rapid bleeding control Timely initial assessment and immediate control of bleeding are crucial in trauma care, as uncontrolled bleeding is a major cause of preventable death. Pressing the wound directly, using a tourniquet, and applying hemostatic drugs-these have been highlighted in measures like "stopping bleeding"-are now common methods for rapid
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