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&NA; Initial interpretation of the process of coagulation refers to two pathways: (1) the extrinsic pathway, consisting of tissue factor (TF) and factor VII, and (2) the intrinsic pathway, in which factors XII, XI, IX, VIII and V are involved. Currently, this concept has changed and it is accepted that the main initiating event in blood coagulation is TF exposure. In this article, we review the new concepts of the coagulation cascade based on thromboelastography findings and the different mechanisms involved in trauma‐associated coagulopathy. For this purpose, a systematic research was carried out using the main databases, including Medline, Embase and Lilacs between 2000 and 2011. One hundred and fourteen articles were found, and 50 were selected for the review. A relevant finding was that thromboelastography allows a precise detection of the underlying flaw in the coagulation cascade. Therefore, this procedure has become an essential tool and a guide for the management of trauma‐associated coagulopathy. &NA; La interpretación inicial del proceso de coagulación mencionaba la presencia de 2 vías: la extrínseca, formada por el factor tisular (FT) y el factor VII, y la intrínseca, en la que participan los factores XII, XI, IX, VIII y V. Hoy en día este concepto ha cambiado y se acepta de forma categórica que el evento iniciador principal de la coagulación sanguínea es la exposición del FT. En este artículo revisamos los nuevos conceptos de la cascada de coagulación con los hallazgos de la tromboelastografía y los diferentes mecanismos que precipitan la coagulopatía asociada al trauma. Para tal fin se realizó una búsqueda sistemática en las principales bases de datos, como Medline, Embase y Lilacs, en el periodo comprendido entre 2000 y 2011. Se encontraron 114 artículos, de los cuales se tomaron 50 para realizar la revisión. Como hallazgo relevante se encontró que la tromboelastografía permite detectar con precisión el defecto subyacente en la cascada de coagulación, y de esta manera se ha convertido en una herramienta útil e indispensable para guiar el manejo de la coagulopatía asociada al trauma.

Thromboelastography: New concepts in haemostasis physiology and correlation with trauma associated coagulopathy