Hypercoagulability after burn injury

Robert M. Van Haren, Chad M. Thorson, Evan J. Valle, Alexander M. Busko, Gerardo A. Guarch, David Andrews, Louis R Pizano, Carl I Schulman, Nicholas Namias, Kenneth G Proctor

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

BACKGROUND: Hypercoagulability is a homeostatic response to trauma, but relatively little information is available about coagulation changes after burn injury. Therefore, we tested the hypothesis that burn patients are hypercoagulable at admission and/or during recovery. METHODS: A prospective observational trialwas conducted at an American Burn Association verified Burn Center. Thromboelastography (TEG) was performed on blood drawn from indwelling catheters upon admission and weekly for those who remained hospitalized. Routine and special coagulation tests were performed on stored samples. Data are expressed as median (interquartile range). RESULTS: Twenty-four patients (88% male) were enrolled, with a median age of 49 (20) years and a median total body surface area burn of 29% (23%); 21 experienced thermal burns (4 inhalational injuries), and 3 had electrical burns. There were no significant differences in TEG or coagulation assays between patients with thermal versus electrical burn injury, but there were significant differences between men versus women and between those with or without inhalational injury. Sixteen patients had repeat samples 1 week after intensive care unit admission. The repeat TEG was more hypercoagulable (all p < 0.05). Fibrinogen and natural anticoagulation proteins (protein C, protein S, and antithrombin III) were also increased (all p < 0.05). Two patients (8%) developed venous thromboembolism (VTE); TEG reaction time, fibrinogen, and partial thromboplastin time were decreased (all p < 0.05) at admission compared with those with no VTE. All changes occurred despite pharmacologic thromboprophylaxis. There was no significant correlation between TEG and total body surface area or between TEG and fluid balance. CONCLUSION: In general, burn patients have normal coagulation parameters at admission but become hypercoagulable during recovery. However, those who are hypercoagulable at admission may have an increased risk of VTE. Additional monitoring and/or thromboprophylaxis may be indicated.

Original languageEnglish
Pages (from-to)37-43
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number1
DOIs
StatePublished - Jul 1 2013

Fingerprint

Thrombelastography
Thrombophilia
Venous Thromboembolism
Wounds and Injuries
Body Surface Area
Burns
Fibrinogen
Hot Temperature
Burn Units
Indwelling Catheters
Water-Electrolyte Balance
Antithrombin III
Partial Thromboplastin Time
Protein S
Protein C
Intensive Care Units

Keywords

  • Burn
  • Coagulation
  • Thromboelastography
  • Venous thromboembolism

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Van Haren, R. M., Thorson, C. M., Valle, E. J., Busko, A. M., Guarch, G. A., Andrews, D., ... Proctor, K. G. (2013). Hypercoagulability after burn injury. Journal of Trauma and Acute Care Surgery, 75(1), 37-43. https://doi.org/10.1097/TA.0b013e3182984911

Hypercoagulability after burn injury. / Van Haren, Robert M.; Thorson, Chad M.; Valle, Evan J.; Busko, Alexander M.; Guarch, Gerardo A.; Andrews, David; Pizano, Louis R; Schulman, Carl I; Namias, Nicholas; Proctor, Kenneth G.

In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 1, 01.07.2013, p. 37-43.

Research output: Contribution to journalArticle

Van Haren RM, Thorson CM, Valle EJ, Busko AM, Guarch GA, Andrews D et al. Hypercoagulability after burn injury. Journal of Trauma and Acute Care Surgery. 2013 Jul 1;75(1):37-43. https://doi.org/10.1097/TA.0b013e3182984911
Van Haren, Robert M. ; Thorson, Chad M. ; Valle, Evan J. ; Busko, Alexander M. ; Guarch, Gerardo A. ; Andrews, David ; Pizano, Louis R ; Schulman, Carl I ; Namias, Nicholas ; Proctor, Kenneth G. / Hypercoagulability after burn injury. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 1. pp. 37-43.
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N2 - BACKGROUND: Hypercoagulability is a homeostatic response to trauma, but relatively little information is available about coagulation changes after burn injury. Therefore, we tested the hypothesis that burn patients are hypercoagulable at admission and/or during recovery. METHODS: A prospective observational trialwas conducted at an American Burn Association verified Burn Center. Thromboelastography (TEG) was performed on blood drawn from indwelling catheters upon admission and weekly for those who remained hospitalized. Routine and special coagulation tests were performed on stored samples. Data are expressed as median (interquartile range). RESULTS: Twenty-four patients (88% male) were enrolled, with a median age of 49 (20) years and a median total body surface area burn of 29% (23%); 21 experienced thermal burns (4 inhalational injuries), and 3 had electrical burns. There were no significant differences in TEG or coagulation assays between patients with thermal versus electrical burn injury, but there were significant differences between men versus women and between those with or without inhalational injury. Sixteen patients had repeat samples 1 week after intensive care unit admission. The repeat TEG was more hypercoagulable (all p < 0.05). Fibrinogen and natural anticoagulation proteins (protein C, protein S, and antithrombin III) were also increased (all p < 0.05). Two patients (8%) developed venous thromboembolism (VTE); TEG reaction time, fibrinogen, and partial thromboplastin time were decreased (all p < 0.05) at admission compared with those with no VTE. All changes occurred despite pharmacologic thromboprophylaxis. There was no significant correlation between TEG and total body surface area or between TEG and fluid balance. CONCLUSION: In general, burn patients have normal coagulation parameters at admission but become hypercoagulable during recovery. However, those who are hypercoagulable at admission may have an increased risk of VTE. Additional monitoring and/or thromboprophylaxis may be indicated.

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