Uncontrolled hemorrhage and multisystem organ failure secondary to coagulopathy are the most common causes of non-brain injury related morbidity and mortality following trauma. Over 25% of patients who present with severe injuries will develop trauma-induced coagulopathy, which results in a fourfold higher risk of death. The pathophysiologic basis of trauma-induced coagulopathy involves a complex and dynamic interaction between coagulation, inflammation, and the immune response and clinically results in phenotypes that may present anywhere on a continuum from hyper- to hypocoagulable. Trauma-induced coagulopathy is common in both adults and in children. Treatment for this requires early, balanced resuscitation with blood products and hemostatic adjuncts, clinical monitoring of coagulation parameters and the physiologic response to transfusion, and prevention of subsequent thromboembolic events.