Richard P. Dutton, MD, MBA; John B. Holcomb, MD, FACS; and Deborah M. Stein, MD, MPH, FACS, discuss the evolving clinical perceptions of acquired coagulopathy and how it is treated. As part of their discussion, these trauma specialists address the use of prohemostatic agents in military and civilian practice, hypotensive resuscitation practices, and standard procedures for utilizing off-label recombinant factor VIIa.