Our international randomized trial has evaluated the role of VHAs to individualize care and augment empiric hemostatic resuscitation in the challenging and time-critical environment of trauma care. Empiric haemostatic therapy was delivered in both arms of the trial, with balanced blood component transfusions, use of tranexamic acid and restricted crystalloid infusions.

Intensive coagulation monitoring was also performed in both arms after every four units of red cell transfusions, with additional hemostatic therapies delivered based on these results. We saw no difference overall in primary or secondary outcomes between CCT and VHA-guided hemostatic therapy.

While this study aimed to explore the effect of VHA-directed assessment and treatment of coagulopathy in trauma patients, the overall prevalence of coagulopathy was lower than we expected.

Nearly three quarters of the patients were not coagulopathic (by PTr) at baseline and very few of these patients subsequently developed a prolonged PTr before hemostasis. These lower rates are likely due to the effect of optimisation of balanced hemostatic therapy with early prehospital and in-hospital use of transfusions prior to randomisation and during hemorrhage.

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