Severe trauma can cause dramatic changes in hemostasis resulting in a severe coagulopathic state.1–3  There has been heightened interest in the fibrinolytic system for its role in exacerbating or increasing this risk of bleeding during the acute post-trauma period, and its relationship with subsequent patient outcomes.2,3 

In this issue, Rossetto et al. report on predictive utility of rotational thromboelastometry (ROTEM)–detected fibrinolysis on admission and at 24 h to identify multiorgan dysfunction syndrome and late mortality. Patients were grouped by maximum lysis according to ROTEM into low, normal, and high fibrinolytic activity based on established criteria. Multivariable logistic regression analysis was used to identify the independent effect of the fibrinolytic states on both multiorgan dysfunction syndrome and mortality. They first examined fibrinolytic transition patterns in 432 (of 731) patients who did not receive tranexamic acid (an antifibrinolytic). The highest incidence of late mortality occurred in patients...

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