In this issue of Anesthesiology, Lindsay et al. present a complex secondary analysis of the ITACTIC trial, part of the Targeted Action for Curing Trauma Induced Coagulopathy (TACTIC) program, funded by the European Commission. ITACTIC was designed to settle an ongoing debate in contemporary trauma science: the clinical utility of viscoelastic testing versus conventional coagulation tests to guide administration of coagulation agents in the setting of early resuscitation with 1:1 units of erythrocytes and plasma. The target population for this prospective, randomized trial was a cohort of 396 injured patients presenting to major European trauma centers with evidence of ongoing hemorrhage. The ITACTIC investigators included some of the leading authorities in resuscitation after trauma, and the results were eagerly awaited by the international community. In defiance of expectations, the study detected no difference in 28-day mortality.

The current article reports results from the Activation of Coagulation...

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