Traumatic coagulopathy: where are the good experimental models?

BACKGROUND The development of coagulopathy associated with trauma is a complex process that involves a combination of many factors. It is important to be able to model experimental trauma-related coagulopathy to explore preventative and therapeutic strategies, and numerous models of traumatic coagulopathy have been explored. This systematic review assessed the primary question "What are relevant experimental models with which to study early traumatic coagulopathy?" and secondary questions on mechanisms. METHODS The author group reviewed 695 abstracts that resulted in 36 articles being fully reviewed by the group. The group identified 12 key studies (grade A) addressing the primary question. A further 10 articles were thought to be relevant but less important (grade B). Eight articles were considered worthwhile publications but not as relevant to the query (grade C), and six articles were considered not relevant after detailed review (grade D). RESULTS This structured literature review demonstrated a lack of relevant models for human traumatic coagulopathy. We identify challenges in modeling traumatic coagulopathy and limitations to current experimental models and include a proposal for features of an "ideal" model of traumatic coagulopathy, but recognize that this involves major challenges. CONCLUSIONS Models of traumatic coagulopathy need to more closely resemble human physiology and real-life conditions if they are to influence clinical practice.