Measuring coagulation in burns: an evidence-based systematic review

Abstract

Introduction:Dynamic monitoring of coagulation is important to predict both haemorrhagic and thrombotic complications and to guide blood product administration. Reducing blood loss and tailoring blood product administration may improve patient outcome and reduce mortality associated with transfusion. The current literature lacks a systematic, critical appraisal of current best evidence on which clinical decisions may be based.Objectives:Establishing the role of different coagulation markers in burn patients, diagnosing coagulopathy, tailoring blood product administration and indicating prognosis.Methods:Literature during 2004–2017 from the Cochrane Library, PubMed, Scopus, Medline and Embase was reviewed. Eligibility criteria included randomised controlled trials, systematic reviews, multi-/single-centre study and meta-analyses. Keywords searched were ‘burns’, ‘blood coagulation disorders’, ‘rotem’, ‘blood coagulation’ and ‘thromboelastography’. The PRISMA flow system was used for stratification and the CASP framework for appraisal of the studies retrieved.Results:In total, 13 articles were included after inclusion/exclusion criteria had been applied to the initial 79 studies retrieved. Hypercoagulation increases in proportion to the severity of thermal injury. Whole blood testing, using thrombelastography (TEG) and rotation thromboelastometry (ROTEM), was superior to standard plasma based tests, including prothrombin time (PT) and activated partial thromboplastin time (APTT) at detecting burn-related coagulopathies.Conclusions:Routine laboratory markers such as PT/APTT are poor indicators of coagulation status in burns patients. Viscoelastic tests, such as TEG and ROTEM, are efficient, fast and have a potential use in the management of burn patients; however, strong evidence is lacking. This review highlights the need for more randomised controlled trials, to guide future practice.

Trajectories of longitudinal biomarkers for mortality in severely burned patients

“…Total bilirubin, which is one of the risk factors in burns 10 , showed a similar pattern with creatinine in our study. The PT is also a known predictor of mortality in trauma patients, but is not a good predictor in burn patients 11 ; however, the mean plot of PT (Fig. 1 ) in this study showed good differentiation between the two groups in both the manners.…”

Coagulopathies in Intensive Care Medicine: Balancing Act between Thrombosis and Bleeding

“…ABIC occurs after 4 to 16 h in approximately 30-40% in patients with severe burns [110,113,115]. Previous studies defined that the ABIC based on INR is higher by 1.2 or 1.3, but laboratory markers, such as INR and aPTT, turned out to be unreliable indicators of coagulation in patients with severe burns [116].…”

Challenges in anaesthesia and pain management for burn injuries

“…53 Laboratory tests of coagulation have proved to be poor predictors of coagulation in burn patients, whereas viscoelastic tests give better real-time indication of coagulopathy as discussed in a recent review. 54 Clot strength and microstructure decreases with progressive haemodilution, which is another risk of over-resuscitation. 55 Blood loss during excision of large burn eschar has the potential to exceed a blood volume, despite the current practice of using tumescent infiltration techniques.…”