Towards optimization in the use of hemostatic agents and blood products in the early treatment of patients with traumatic brain injury (TBI).

Purpose of the review: The treatment of patients with traumatic brain injury (TBI) with subsequently evolving hemostatic failure and hemorrhagic lesion progression remains challenging. New studies highlight windows of opportunity for treatment optimization.

Recent findings: Results from recent randomized studies suggest an earlier treatment with antifibrinolytic tranexamic acid at a higher initial bolus dose. There seems to be a new window of opportunity for the early prehospital use of thawed plasma. Viscoelastic-based goal-directed treatment strategies are still not delivered timely in most patients although a recent meta-analysis has confirmed a survival benefit with this approach.

Summary: Mortality in TBI with subsequent evolving hemostatic failure can be reduced through treatment optimization delivering early prehospital high-dose tranexamic acid and in-hospital goal-directed treatment algorithms to timely correct coagulopathy and restore hemostasis.