PROJECT SUMMARY Venous thromboembolism (VTE) continues to be a major health problem with over 500,000 VTE events in the US annually. Venous thromboembolism costs more than $8 billion per year to our health care system and causes more than 100,000 deaths per year in the US alone. Venous thromboembolism is particularly problematic in patients who experience trauma. Despite administration of chemoprophylaxis to trauma patients during hospitalization, about 5% of patients still develop symptomatic VTE prior to discharge, and, more alarmingly, 40 - 60% of patients who develop symptomatic VTE, do so after discharge. An accurate assessment of traumatic- injury based coagulopathies remains dependent on unavailable basic scientific knowledge needed to address the National Institutes of Health (NIH) initiative of defining the “role of laboratory monitoring…to help better define those at risk of bleeding and thrombosis.” To understand the etiologies of trauma-induced venous thromboembolism, a comprehensive approach that assesses plasma coagulation factor activities, platelet reactivity, and endothelial function within the context of pre-trauma patient characteristics (sex, BMI, smoking etc.) and “real-time” blood studies at the time of trauma is required”. Obtaining integrated lab and clinical data from a diverse trauma patient population is not readily feasible in a single investigator’s laboratory or site. The long-term goal is to develop novel predictive, diagnostic and treatment strategies that identify “at risk” individuals for VTE or bleeding soon after trauma. Our Central Hypothesis is that clinically significant thrombosis requires the integrated dysregulation of NETosis, thrombin generation, endothelial injury, and von Willebrand factor- platelet dysfunction. Our collaboration embodies all of the elements needed to improve the quality of care of trauma patients. The investigators are from multiple health-related professions and this leverages experiences and knowledge from different, but related disciplines. Our collaboration also encourages and fosters scientific inquiry with the scientific expertise that will create and disseminate new knowledge and applications. Finally, the team science approach that we have culminated is expected to provide for the highest quality of care and improvement of trauma health outcomes.