Acute coagulopathy in trauma: with or without shock? That is the question

In an interesting and original article in a recent issue of Critical Care, Oshiro and colleagues describe the profile of acute coagulopathy of trauma-shock (ACOTS) using viscoelastic techniques [1]. The authors, in light of their results, demonstrate the hypothesis that ACOTS is a type of disseminated intravascular coagulation (DIC) with a fibrinolytic profile. However, we would like to highlight some aspects we consider to be of interest. It has caught our attention that, fulfilling national laws, patients were not subjected to fluid resuscitation during transport to the hospital. We understand that aggressive fluid resuscitation is deleterious to the patient and induces the possibility of dilutional coagulopathy [2–4]. However, despite the absence of strong evidence in this respect, current guidelines recommend its administra-