Key messages
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Contemporary approaches to haemorrhage control combine early control of bleeding, management of coagulopathy, maintenance of critical perfusion, and management of the inflammatory response
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Early haemorrhage control minimises genomic activation and the harmful inflammation and coagulopathy caused by shock and resuscitation
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Topical haemostatic agents and interventional radiology are useful adjuncts to surgical control of bleeding
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Several pathogenic mechanisms contribute to trauma-induced coagulopathy, and the predominant mechanism changes during the clinical course
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Blind unguided protocols for blood component therapy in haemorrhagic shock and coagulopathy have safety and logistic concerns and trials of their effectiveness are underway
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Systemic treatments for coagulopathy might reduce the reliance on and demand for blood products
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Broad-acting drugs, such as tranexamic acid, that potentially affect inflammation, coagulation, and fibrinolysis, could modify responses to shock and improve outcomes
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In the future, treatments for haemorrhagic shock will be tailored to an individual's response by use of point-of-care tests and targeted therapies