Hypothermia can negatively affect coagulation, resulting in a coagulopathy.
The coagulopathy is most noticeable when body temperature is <= 34°C.
Between 33 and 37°C there may be defects in decreased platelet function and adhesion.
Below 33°C there is both defective platelet function and a reduction in coagulation factor activity. Coagulation factor enzyme activity decreases 10% for each 1°C decrease in temperature.
The defective coagulation enzyme activity in the patient may not be reflected in laboratory tests performed at 37°C. Thromboelastography may be a better measure of coagulation status.
The defects seen with hypothermia results in less stable clots, which contributes to hemorrhage.
The defects related to the hypothermia may be mixed with other coagulation defects associated with comorbid disease, medications, and hypocalcemia.
Fibrinolysis does not appear to be affected by temperature.
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