Traumatic brain injury (TBI) often develops secondary coagulopathy (TBI-IC), which is characterized by a hypercoagulable state that leading to intracranial and systemic ischemic events and rapidly developing into a consumptive hypocoagulable state that leading to hemorrhagic injuries. These two coagulative states in patients with TBI are highly integrated and closely associated with poor outcomes. It has become the consensus that early diagnosis and correction of TBI-IC improve survival and neurological outcomes. However, the underlying mechanisms of TBI-IC remain poorly understood, and there is a lack of effective treatment. This article will review the clinical course, potential pathophysiological mechanism and treatment strategy of TBI-IC, hoping to provide reference for better guidance of clinical diagnosis and treatment of TBI-IC. Copyright © 2020 by the Editorial Board of Chinese Journal of Contemporary Neurology and Neurosurgery.