Novel nonsurgical approaches to bleeding control offer hope for improved management of the critical trauma-related coagulopathy and diffuse bleeding that often typify major trauma and pose challenges to surgeons and anesthetists. Although surgical treatment is the cornerstone of bleeding control, in selected patients angiographic embolization is increasingly used early in patient care to successfully manage arterial bleeding attributable to blunt solid organ injury or posterior pelvic ring disruption. Coagulopathic derangements in trauma occur early and require avoidance or correction of acidosis and hypothermia. If bleeding cannot be stopped by these measures, adjunctive use of fibrinogen or recombinant activated factor VII (rFVIIa) have the potential to correct systemic coagulopathy associated with massive blood loss and its management.