Advancing in the understanding of coagulopathy during hemorrhagic shock: From the triad to the deadly pentad

  • Manuel Quintana-Díaz Intensive Medicine Service, Hospital Universitario La Paz, Universidad Autónoma de Madrid. Madrid, Spain.
  • Manuel Garay-Fernández a. Internal Medicine, Pulmonology and Intensive Care, Universidad El Bosque. Bogotá, Colombia. b. Internal Medicine, Pulmonology and Intensive Care, Hospital Santa Clara. Bogotá, Colombia.
  • Fredy Ariza-Cadena Anesthesia and Perioperative Medicine. Trauma and Major Surgery Division. Fundación Valle del Lili. Universidad ICESI, Universidad del Valle. Cali, Colombia.
Keywords: Coagulation disorders, Hemorrhage, Acidosis, Hypothermia, Calcium, Hyperglycemia, Anesthesiology


The deadly triad concept represented a dogma in the definition of poor outcomes and death associated with major bleeding in trauma. This model of end-stage disease was then rapidly transferred to other major bleeding scenarios. However, and notwithstanding the fact that it represented a severe scenario, the original triad fails to establish a sequence, which would be relevant when defining the objectives during the initial treatment of severe bleeding.  It has been recently suggested that hypoxia and hyperglycemia should be included as isolated, determining factors in this model. Likewise, the model admits only one scenario where all the conditions shall co-exist, knowing that each one of them contributes with a different risk burden. Based on a structured review, we submit a pentad model that includes a natural pattern of events occurring with hypoxemia as the main trigger for the development of hypocalcemia, hyperglycemia, acidosis and hypothermia, as hallmarks of multiple system impairment. This severity model of major bleeding ends with coagulopathy as a result of the failure to resolve the rest of the previous components.


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How to Cite
Quintana-Díaz M, Garay-Fernández M, Ariza-Cadena F. Advancing in the understanding of coagulopathy during hemorrhagic shock: From the triad to the deadly pentad. Colomb. J. Anesthesiol. [Internet]. 2022 May 13 [cited 2022 Dec. 2];50(4). Available from:


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How to Cite
Quintana-Díaz M, Garay-Fernández M, Ariza-Cadena F. Advancing in the understanding of coagulopathy during hemorrhagic shock: From the triad to the deadly pentad. Colomb. J. Anesthesiol. [Internet]. 2022 May 13 [cited 2022 Dec. 2];50(4). Available from:
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