Thrombin Generation in Trauma Patients: How Do we Navigate Through Scylla and Charybdis?

Purpose of Review Coagulopathy is a complex pathological condition manifested through the insufficient or excessive tendency to form blood thrombi, which can be caused by trauma and surgery. A promising strategy to mitigate coagulopathy is the balanced restoration of the generation of thrombin — the main enzyme in the blood-coagulation system. We review studies focusing on thrombin, traumatic coagulopathy, and hemostatic balance — a concept aimed to avoid abnormally weak or excessively strong coagulation responses. Recent Findings Thrombin generation is impacted by coagulopathic conditions described by complex patterns, possibly depending on various factors. New methodologies of thrombin-generation measurement and analysis are emerging. Combinations of pro- and anticoagulant proteins can restore thrombin generation in coagulopathy. Balanced therapeutic strategies to improve thrombin generation may lead to favorable clinical outcomes. Summary Thrombin generation is an essential target of pharmacological intervention in traumatic and surgical coagulopathy. Graphic Abstract