Point-of-Care Testing in Burn Patients

Wiegele, Marion; Kozek‐Langenecker, Sibylle A.; Schaden, Eva

doi:10.1055/s-0037-1599155

Cited by 14 publications

(11 citation statements)

References 43 publications

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“…The ROTEM investigations included a regular extrinsically activated (EXTEM) assay, which was conducted as per the manufacturer’s instructions to detect extrinsically activated clotting dynamics [ 13 , 14 ]. In addition, we used two modified assays known to correlate with anti-Xa levels in vitro: low-tissue-factor (low-TF) and prothrombinase-induced clotting time (PiCT) ROTEM [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

“…The linear regressions in Figure 2 revealed that clot initiation did not correlate with anti-Xa trough levels in the modified PiCT (rho = 0.11; p = 0.29) and low-TF (rho = 0.01; p = 0.88) assays throughout the four examinations at baseline and on days A to C of hemodialysis. and by two modified assays of low-TF (low-tissue-factor) ROTEM and PiCT (prothrombinase-induced clotting) NATEM (i.e., non-activated ROTEM) known to correlate greatly with anti-Xa levels [14]. Median values for the four examinations are connected by horizontal lines, with vertical lines extending from the 1st to 3rd The area highlighted in gray indicates the only available reference range (for CT by EXTEM).…”

Section: Rotem Parameters During Crrtmentioning

confidence: 99%

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Monitoring of Enoxaparin during Hemodialysis Covered by Regional Citrate Anticoagulation in Acute Kidney Injury: A Prospective Cohort Study

Wiegele

Adelmann

Dibiasi

et al. 2021

JCM

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Background: Current guidelines recommend the monitoring of anti-factor Xa (anti-Xa) levels to avoid an accumulation of low-molecular-weight heparins in patients with acute kidney injury, but there is no evidence on how to proceed with such monitoring during continuous renal replacement therapy. Against this background, we investigated the potential accumulation of enoxaparin administered subcutaneously for venous thromboembolism prophylaxis in critically ill patients during continuous renal replacement therapy covered by regional citrate anticoagulation. Methods: Anti-Xa levels were measured at baseline (≤12 h before renal replacement therapy) and on three consecutive days (A to C) when enoxaparin had reached trough levels. Supplementary testing included modified assays of rotational thromboelastometry known to be highly sensitive for low-molecular-weight heparins. Results: The 16 men and 13 women included were adults comparable in age, body mass index, thromboembolism risk assessment, and clinical severity of the disease. Throughout the four examinations, the median trough levels of anti-Xa remained below the detection limit of the test (<0.1 IU mL−1), with interquartile ranges of <0.1 to 0.14 IU mL−1 at baseline and <0.1 to 0.16 IU mL−1 on days A/B/C. All rotational thromboelastometry parameters of clot initiation and clot formation dynamics did not significantly change from baseline to day C. Conclusions: Neither anti-Xa levels nor modified assays of rotational thromboelastometry revealed any accumulation of enoxaparin administered for thromboprophylaxis during continuous renal replacement therapy covered by regional citrate anticoagulation. Although generally recommended in patients with acute kidney injury, monitoring of anti-Xa levels should be questioned in this defined setting.

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Section: Methodsmentioning

confidence: 99%

Section: Rotem Parameters During Crrtmentioning

confidence: 99%

Monitoring of Enoxaparin during Hemodialysis Covered by Regional Citrate Anticoagulation in Acute Kidney Injury: A Prospective Cohort Study

Wiegele

Adelmann

Dibiasi

et al. 2021

JCM

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“…In addition, five microsurgical revisions were required because of arterial thrombosis (7%), venous insufficiency (14%), or hematoma (14%). Routine rotational thromboelastometry (ROTEM) during preoperative evaluation showed hypercoagulopathy in ten patients (71%) consistent with a hypercoagulative state that is described as beginning 48 h after trauma [ 20 , 35 , 36 ]. All documented operative revisions and flap loss occurred in patients with altered coagulation and nearly all complications occurred in patients with a delay of 19 to 30 days between burn trauma and defect reconstruction.…”

Section: Outcome and Complicationsmentioning

confidence: 99%

Implementation and Validation of Free Flaps in Acute and Reconstructive Burn Care

et al. 2021

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Microsurgical free flap reconstruction in acute burn care offers the option of reconstructing even challenging defects in a single stage procedure. Due to altered rheological and hemodynamic conditions in severely burned patients, it bears the risk of a higher complication rate compared to microsurgical reconstruction in other patients. To avoid failure, appropriate indications for free flap reconstruction should be reviewed thoroughly. Several aspects concerning timing of the procedure, individual flap choice, selection and preparation of the recipient vessels, and perioperative measures must be considered. Respecting these specific conditions, a low complication rate, comparable to those seen in microsurgical reconstruction of other traumatic limb defects, can be observed. Hence, the free flap procedure in acute burn care is a relatively safe and reliable tool in the armamentarium of acute burn surgery. In reconstructive burn care, microsurgical tissue transfer is routinely used to treat scar contractures. Due to the more robust perioperative condition of patients, even lower rates of complication are seen in microsurgical reconstruction.

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“…3,32 What has emerged in recent years is that it is no longer sufficient to rely solely on plasmatic prothrombin time, international normalized ratio, or activated partial thromboplastin time to diagnose coagulopathy and guide treatment. 3,[33][34][35][36][37] Other trauma trials suggest that similar limitations may also apply to relying exclusively on single point parameters from viscoelastic methods (e.g., clot times and indices of clot lysis). [38][39][40] Fig .…”

Section: Trauma-induced Coagulopathy: a Bewildering Heterogeneitymentioning

confidence: 99%

Traumatic-Induced Coagulopathy as a Systems Failure: A New Window into Hemostasis

Dobson

Morris

Davenport

et al. 2020

Semin Thromb Hemost

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Traumatic-induced coagulopathy (TIC) is often associated with significant bleeding, transfusion requirements, inflammation, morbidity, and mortality. This review considers TIC as a systems failure, not as a single-event manifestation of trauma. After briefly reviewing the meaning of TIC and the bewildering array of fibrinolysis phenotypes, we will discuss the role of platelets and fibrinogen in coagulopathy. Next, we will review the different TIC hypotheses and drill down to a single mechanistic domain comprising (1) thrombin's differential binding to thrombomodulin, (2) the expression of annexin II-S100A10 complex, and (3) the functional integrity of the endothelial glycocalyx. This triad forms the basis of the “switch” hypothesis of TIC. We will next address the potential limitations of current practice in treating a coagulation or fibrinolytic defect, and the next defect, and so on down the line, which often leads to what U.S. surgeon William C. Shoemaker considered “an uncoordinated and sometimes contradictory therapeutic outcome.” The treat-as-you-go approach using sequential, single-target treatments appears to be a by-product of decades of highly reductionist thinking and research. Lastly, we will present a unified systems hypothesis of TIC involving three pillars of physiology: the central nervous system (CNS)–cardiovascular system, the endothelial glycocalyx, and mitochondrial integrity. If CNS control of ventriculoarterial coupling is maintained close to unity following trauma, we hypothesize that the endothelium will be protected, mitochondrial energetics will be maintained, and TIC (and inflammation) will be minimized. The Systems Hypothesis of Trauma (SHOT) also helps to answer why certain groups of severely bleeding trauma patients are still dying despite receiving the best care. Currently, no drug therapy exists that targets the whole system.

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Point-of-Care Testing in Burn Patients

Cited by 14 publications

References 43 publications

Monitoring of Enoxaparin during Hemodialysis Covered by Regional Citrate Anticoagulation in Acute Kidney Injury: A Prospective Cohort Study

Monitoring of Enoxaparin during Hemodialysis Covered by Regional Citrate Anticoagulation in Acute Kidney Injury: A Prospective Cohort Study

Implementation and Validation of Free Flaps in Acute and Reconstructive Burn Care

Traumatic-Induced Coagulopathy as a Systems Failure: A New Window into Hemostasis

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