Degree of Hypercoagulability and Hyperfibrinolysis is Related to Organ Failure and Prognosis after Burn Trauma

García-Avello, Ángel; Lorente, José A.; Cesar-Perez, J.; García-Frade, Luis Javier; Alvarado, Raúl; Arévalo, José M.; Navarro, José Luís; Esteban, A

doi:10.1016/s0049-3848(97)00291-0

Cited by 104 publications

(86 citation statements)

References 27 publications

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“…This physiologically important molecule is deficient in pathological conditions such as thermal injury [7][8][9]. The resulting hypercoagulable state in burn patients leads to the impaired tissue perfusion, which may result in multiple organ derangements, including pulmonary dysfunction and delayed wound healing.…”

Section: Discussionmentioning

confidence: 99%

“…Burn patients develop an imbalance between pro-and anti-coagulant elements. It has been reported that the hypercoagulable state in burn patients during the initial 24 h was associated with high levels of activated Factor VII, thrombin/antithrombin complex, PAI-1 (plasminogen activator inhibitor-1), and low levels of antithrombin and protein C [7]. In addition, a number of investigators have documented that plasma concentrations of antithrombin are markedly reduced in burn patients [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Combined anticoagulants ameliorate acute lung injury in sheep after burn and smoke inhalation

et al. 2008

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Burn and smoke inhalation-related multiple organ dysfunction is associated with a severe fall in the plasma concentration of antithrombin. Therefore the aim of the present study was to test the hypothesis that intravenous administration of recombinant human antithrombin in combination with aerosolized heparin will ameliorate acute lung injury in sheep exposed to cutaneous burn and smoke inhalation. Sheep were prepared operatively for study and, 7 days post-surgery, sheep were given a cutaneous burn (40% of total body surface area, third-degree burn) and insufflated with cotton smoke (48 breaths, <40 degrees C) under halothane anaesthesia. After injury, sheep were placed on a ventilator and resuscitated with Ringer's lactate solution. The animals were divided into three groups: sham group (non-injured and non-treated; n=6), saline group (injured and received saline; n=6) and rhAT.iv.+Hep group [injured and treated with rhAT (recombinant human antithrombin) and heparin; n=6]. In the rhAT.iv.+Hep group, rhAT was infused continuously for 48 h starting 1 h post-injury with a dose of 0.34 mg.h(-1).kg(-1) of body weight and heparin (10000 units) was aerosolized every 4 h starting at 1 h post-injury. The experiment lasted 48 h. Haemodynamics were stable in sham group, whereas the saline-treated sheep developed multiple signs of acute lung injury, including decreased pulmonary gas exchange, increased inspiratory pressures, extensive airway obstruction and increased pulmonary oedema. These pathological changes were associated with a severe fall in plasma antithrombin concentration, lung tissue accumulation of leucocytes and excessive production of NO. Treatment of injured sheep with anticoagulants attenuated all of the pulmonary pathophysiology observed. In conclusion, the results provide definitive evidence that anticoagulant therapy may be a novel and effective treatment tool in the management of burn patients with concomitant smoke inhalation injury.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Combined anticoagulants ameliorate acute lung injury in sheep after burn and smoke inhalation

et al. 2008

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“…Smooth muscle myosin heavy chain 9 and elastin 10 have been proposed as specific markers of AAD, but rapid measurement systems are not clinically available. In general, DD is used in cases of suspected coagulation activation and in all clinical conditions with ongoing fibrinolysis, such as disseminated intravascular coagulation, 11 liver cirrhosis, 12 fulminant hepatitis, 13 malignancy, 14 burn, 15 aortic aneurysm, 16 pulmonary embolism, [17][18][19] deep vein thrombosis, 4,5,20,21 and acute coronary syndrome. 22,23 D-dimer is a useful diagnostic marker for pulmonary embolism and deep vein thrombosis because of the high negative predictive value.…”

Section: Discussionmentioning

confidence: 99%

A Rapid Bedside D-Dimer Assay (Cardiac D-Dimer) for Screening of Clinically Suspected Acute Aortic Dissection

Akutsu

Sato

Yamamoto

et al. 2005

Circ J

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cute aortic dissection (AAD) can be fatal and should be diagnosed as early as possible. Without treatment, mortality increases by 1% per hour during the first 48 h. 1 Acute aortic dissection has traditionally been diagnosed by computed tomography (CT) because a rapid laboratory test has not been available. However, if the possibility of AAD could be ruled out, contrast-enhanced CT, which is time-consuming and impairs renal function with contrast media, would be unnecessary. Both the coagulation and fibrinolytic systems are reportedly activated in cases of AAD. 2 Weber et al found that assay of D-dimer (DD), a specific degradation product of cross-linked fibrin, had 100% sensitivity but only 69% specificity for detection of AAD. 3 A rapid bedside DD assay (Cardiac D-dimer, Roche Diagnostics, Mannheim, Germany) was recently developed for detection of pulmonary embolism and deep vein thrombosis. 4,5 One characteristic of patients with AAD is elevated systolic blood pressure, 1 and we hypothesized that elevated blood pressure could serve as a diagnostic indicator in cases of suspected AAD. Therefore, the first goal of the present study was to show the utility of rapid bedside DD assay in the detection of AAD. The second goal was to clarify whether positive predictive value could be increased if the rapid bedside DD assay value and blood pressure reading upon admission were used in combination. Circulation Journal Vol.69, April 2005 Methods PatientsThe study group included consecutive patients in whom AAD was suspected or not ruled out, who were admitted to the coronary care unit during the period November 2002 through June 2004 and in whom the DD level was determined by rapid bedside assay. Acute aortic dissection was suspected in patients with sudden onset of chest and/or back pain and no definitive electrocardiographic findings of Background A rapid laboratory test for diagnosis of acute aortic dissection (AAD) has not been available. We performed this prospective study to determine the utility of a rapid bedside D-dimer (DD) assay for detection of AAD. Methods and ResultsPatients with suspected AAD were recruited and their DD levels were measured by rapid bedside assay. They were divided into 2 groups according to enhanced computed tomography findings: an AAD group (n=30) and a non-AAD group (n=48). The median DD level was higher in the AAD group (1.80 g/ml) than in the non-AAD group (0.42 g/ml) (p=0.000). The rapid bedside DD assay showed 100% sensitivity, 54% specificity, 58% positive predictive value and 100% negative predictive value for detection of AAD with a normal DD level of up to 0.5 g/ml. The combination of DD level >0.5 g/ml and systolic blood pressure ≥180 mmHg showed 86% positive predictive value for detection of AAD.Conclusions We conclude that the rapid bedside DD assay is a highly sensitive method for early exclusion of AAD in patients with chest and/or back pain suggestive of AAD. Acute aortic dissection is highly probable if a rapid DD assay shows the elevated DD level with systolic blood press...

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“…Thus, PT, aPTT, and Fbg levels provide only a superficial impression of hemostasis and become abnormal only when severe coagulation-related disorders are established. Acute thermal injury initiates an activation of coagulation and fibrinolysis resulting in either an overt or non-overt DIC, which increases in severity with the severity of the injury (%TBSA/inhalation injury) [35,47,48] . These hemostatic abnormalities are a result of increased consumption of coagulation and fibrinolytic factors, dilution by the resuscitative fluids, and loss of plasma and fluids through the injured integument.…”

Section: Dicmentioning

confidence: 99%

Antithrombin in the treatment of burn trauma

Kowal-Vern

Orkin

2016

WJCCM

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Antithrombin (AT) is a natural anticoagulant with antiinflammatory properties that has demonstrated value in sepsis, disseminated intravascular coagulation and in burn and inhalation injury. With high doses, AT may decrease blood loss during eschar excision, reducing blood transfusion requirements. There are no human randomized, placebo-controlled studies, which have tested the true benefit of this agent in these conditions. Two main forms of AT are either plasma-derived AT (phAT) and recombinant AT (rhAT). Major ovine studies in burn and smoke inhalation injury have utilized rhAT. There have been no studies which have either translated the basic rhAT research in burn trauma, or determined the tolerance and pharmacokinetics of rhAT concentrate infusions in burn patients. Advantages of rhAT infusions are no risk of blood borne diseases and lower cost. However, the majority of human burn patient studies have been conducted utilizing phAT. Recent Japanese clinical trials have started using phAT in abdominal sepsis successfully. This review examines the properties of both phAT and rhAT, and analyzes studies in which they have been utilized. We believe that it is time to embark on a randomized placebo-controlled multi-center trial to establish the role of AT in both civilian and military patients with burn trauma.

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Degree of Hypercoagulability and Hyperfibrinolysis is Related to Organ Failure and Prognosis after Burn Trauma

Cited by 104 publications

References 27 publications

Combined anticoagulants ameliorate acute lung injury in sheep after burn and smoke inhalation

Combined anticoagulants ameliorate acute lung injury in sheep after burn and smoke inhalation

A Rapid Bedside D-Dimer Assay (Cardiac D-Dimer) for Screening of Clinically Suspected Acute Aortic Dissection

Antithrombin in the treatment of burn trauma

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