Coagulopathy after traumatic injury has multiple etiologies. It may result from overwhelming activation of tissue factor, consumption of circulating coagulation proteins, massive transfusion, metabolic alterations, hypothermia, or any combination of these factors. Despite advances in trauma resuscitation, the problem of persistent, life-threatening coagulopathy continues to pose a significant challenge for the healthcare team, and sometimes is an insurmountable obstacle in the path to recovery of the patient with trauma. Development of a coagulopathy has a significant impact on the morbidity and mortality of the patient with trauma. This article describes the relevant pathophysiology as it relates to the development of a coagulopathy, prevention strategies, and management principles applied in caring for the patient with trauma and a coagulopathy.