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Exsanguination is responsible for 30% to 40% of trauma-related deaths. 1, 2 Most of these fatalities occur in the prehospital setting. According to standard coagulation tests (SCTs), one quarter to one third of trauma patients present with coagulopathy on admission to the emergency department. 3Y5 The presence of coagulopathy increases the risk for poor outcomes, thus resulting in threefold to fourfold higher mortality rates. 3, 5 Coagulopathic patients are at risk of exsanguination. It is assumed that up to 20% of these fatalities are potentially preventable by early hemostatic intervention. 6 Therefore, timely and reliable identification of the underlying cause of bleeding is paramount to improve survival. Despite remarkable advances in knowledge, the etiology of trauma-induced coagulopathy (TIC) is still not fully understood. Recent concepts suggest an ‘‘endogenous’’TIC primarily driven by shock-associated …