Hypercoagulability after burn injury

Haren, Robert M. Van; 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.

doi:10.1097/ta.0b013e3182984911

Cited by 70 publications

(54 citation statements)

References 25 publications

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“…Recently, in burn patients, we reported a reduced R time in those who developed DVT. 19 In all these previous studies, including our own, the difference in TEG was ''statistically'' significant, but it might be difficult to make clinical decisions based on an R or MA values that are only slightly outside the normal range.…”

Section: Discussionmentioning

confidence: 95%

“…There is no routine laboratory test for hypercoagulability, and shortened PT or PTT have little relevance. Various studies identify differences in TEG R time, 19,26 MA, 17 and platelet numbers or function. 28 In this present study, hypercoagulability was defined as one or more TEG variables outside the standard reference range.…”

Section: Discussionmentioning

confidence: 98%

“…TEG was performed in duplicate on native whole blood samples with no activation material. 19 TEG parameters included: reaction time (R), k time (K), > angle (in degree), maximum amplitude (MA), G value (G), and LY30. 19 Hypercoagulability was defined by values outside standard reference ranges, specifically R G 9 minutes, K G 2 minutes, > angle 9 58-, or MA of 9 64 mm.…”

Section: Methodsmentioning

confidence: 99%

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Hypercoagulability and other risk factors in trauma intensive care unit patients with venous thromboembolism

Haren

Valle

Thorson

et al. 2014

Journal of Trauma and Acute Care Surgery

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Hypercoagulability and other risk factors in trauma intensive care unit patients with venous thromboembolism

Haren

Valle

Thorson

et al. 2014

Journal of Trauma and Acute Care Surgery

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“…Albeit those studies have been conducted in populations with a high incidence of in-house thromboembolism, such as trauma patients, current evidence supporting an association between TEG and clinical VTE is scarce [14][15][16][17]. When used as a predictor of DVT or pulmonary embolism, TEG has shown considerable variability in sensitivity and specificity among studies.…”

Section: Introductionmentioning

confidence: 96%

Thromboelastographic predictors of venous thromboembolic events in critically ill patients

Tartamella

Vassallo

Berlot

et al. 2016

Blood Coagulation &Amp; Fibrinolysis

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Deep venous thromboembolism and pulmonary embolism are still underdiagnosed in the ICU. Thromboelastography (TEG) has shown considerable variability in sensitivity and specificity as a predictor of venous thromboembolism (VTE). We designed a prospective double-blind observational study to predict the risk of VTE using TEG in a cohort of critically ill patients. Seventy-two hours after admission in the ICU and consequent prophylaxis with low-molecular-weight heparin, we performed compressive color-Doppler ultrasound and diagnosed deep venous thrombosis. Computed tomography scan was performed for the diagnosis of pulmonary embolism if pulmonary embolism was suspected based on physical examination and transthoracic echocardiography. Whole blood samples were obtained from central venous lines 6-8 h after subcutaneous administration of low-molecular-weight heparin. Native TEG and modified heparinase TEG were performed using a Thromboelastograph Coagulation Analyzer. Fifty-seven patients were consecutively enrolled of which six (10.5%) developed deep venous thrombosis; two (3.5%) also developed pulmonary embolism. The native thrombodynamic ratio (TDR) was an independent predictor of the odds of thrombosis (odds ratio 1.016, P < 0.05, 95% confidence interval 1.008-1.047), with a 0.93 area under the ROC curve. Using 10.6 as the lower cut-off point, TDR showed 100% sensitivity and 0 negative likelihood ratio (95% confidence interval 0-0.4) in excluding the clinical diagnosis of VTE. Our results show that TDR predicts VTE in the ICU. Our findings are in agreement with those reported by other investigators, who demonstrated that a TDR less that 10 is associated with prophylactic levels of anti-Xa.

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“…[23, 29, 30] It has been previously shown that thermally injured patients become hyper-coagulable within one week of burn injury, despite a normal coagulation profile on admission. [31] In regards to the PICC line itself, PICC associated UEDVT typically occurs day 7–14 after line insertion. [7, 9] This was in fact observed in our patient population, where UEDVT occurred on post-insertion day 7, 9, and 9 respectively, despite all receiving chemical thrombo-prophylaxis (Table 4).…”

Section: Discussionmentioning

confidence: 99%

Peripherally Inserted Central Venous Catheter Safety in Burn Care

Austin

Shahrokhi

Bolourani

et al. 2015

Journal of Burn Care & Research

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Objective PICC line use for central venous access in thermally injured patients has increased in recent years despite a lack of evidence regarding safety in this patient population. A recent survey of invasive catheter practices among 44 burn centers in the United States found that 37% of burn units use PICC lines as part of their treatment protocol. The goal of this study was to compare PICC associated complication rates to existing literature in both the critical care and burn settings. Methods A single institution retrospective cohort review of patients who received a PICC line during admission to a regional burn unit between 2008–2013. Fifty-three patients were identified with a total of seventy-three PICC lines. The primary outcome measurement for this study was indication for PICC line discontinuation. Results The most common reason for PICC line discontinuation was that the line was no longer indicated (45.2%). Four cases of symptomatic upper extremity deep vein thrombosis (5.5%) and 3 cases of central line associated bloodstream infection (4.3%, 2.72 infections per 1000 line days) were identified. PICC lines were in situ an average of 15 days [range 1–49 days]. Conclusions We suggest that PICC line associated complication rates are similar to those published in the critical care literature. Though these rates are higher than those published in the burn literature, they are similar to CVC associated complication rates. While PICC lines can be a useful resource in the treatment of the thermally injured patient, they are associated with significant, and potentially fatal risks.

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Hypercoagulability after burn injury

Abstract: Epidemiologic/prognostic study, level III.

Cited by 70 publications

References 25 publications

Hypercoagulability and other risk factors in trauma intensive care unit patients with venous thromboembolism

Hypercoagulability and other risk factors in trauma intensive care unit patients with venous thromboembolism

Thromboelastographic predictors of venous thromboembolic events in critically ill patients

Peripherally Inserted Central Venous Catheter Safety in Burn Care

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