Marion Wiegele1, Eva Schaden2, Stefan Koch3, Daniel Bauer4, Christoph Krall5, Dieter Adelmann6. 1. Department of Anaesthesia, Critical Care and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. Electronic address: marion.wiegele@meduniwien.ac.at. 2. Department of Anaesthesia, Critical Care and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. Electronic address: eva.schaden@meduniwien.ac.at. 3. Department of Anaesthesia, Critical Care and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. Electronic address: stefan.koch@meduniwien.ac.at. 4. Department of Anaesthesiology and Intensive Care Medicine, Landeskrankenhaus Steyr, Sierninger Straße 170, 4400 Steyr, Austria. Electronic address: daniel.bauer@gespag.at. 5. Center for Medical Statistics, Informatics and Intelligent Systems, Section of Medical Statistics, Medical University of Vienna, Spitalgasse 23, 1090 Wien, Austria. Electronic address: christoph.krall@meduniwien.ac.at. 6. Department of Anaesthesia, Critical Care and Pain Medicine, Division of General Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; Department of Anesthesia & Perioperative Care, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA. Electronic address: dieter.adelmann@ucsf.edu.
Abstract
BACKGROUND: Severe burns can induce a hypercoagulable state which is not depicted in conventional coagulation assays. The thrombin generation assay allows global assessment of coagulation and can identify hypercoagulability. We report changes in thrombin generation in patients after severe burn injury. METHODS: We measured TGA, rotational thrombelastometry and conventional assays in 20 consecutive patients with a total body surface area burned of >20% over a 2-week period: the day after burn trauma (A), the morning after surgical excision of burn wounds (B) and on post-admission days 7 (C) and 14 (D). RESULTS: Thrombin generation assay showed a procoagulatory state: there was an increase in the velocity of thrombin generation (increase in time to peak of +13%, increase in velocity index of +22%), and peak amount of thrombin (+25%) between days A and B. All parameters reached their highest levels on day C and returned towards normal on day D. Rotational thrombelastometry showed a hypercoagulable state with an increase in clot firmness and alpha angle. Conventional coagulation tests remained within reference values. CONCLUSIONS: In the first two weeks following burn, both the thrombin generation assay and rotational thrombelastometry show a hypercoagulable state, while conventional coagulation tests remain normal.
BACKGROUND: Severe burns can induce a hypercoagulable state which is not depicted in conventional coagulation assays. The thrombin generation assay allows global assessment of coagulation and can identify hypercoagulability. We report changes in thrombin generation in patients after severe burn injury. METHODS: We measured TGA, rotational thrombelastometry and conventional assays in 20 consecutive patients with a total body surface area burned of >20% over a 2-week period: the day after burn trauma (A), the morning after surgical excision of burn wounds (B) and on post-admission days 7 (C) and 14 (D). RESULTS:Thrombin generation assay showed a procoagulatory state: there was an increase in the velocity of thrombin generation (increase in time to peak of +13%, increase in velocity index of +22%), and peak amount of thrombin (+25%) between days A and B. All parameters reached their highest levels on day C and returned towards normal on day D. Rotational thrombelastometry showed a hypercoagulable state with an increase in clot firmness and alpha angle. Conventional coagulation tests remained within reference values. CONCLUSIONS: In the first two weeks following burn, both the thrombin generation assay and rotational thrombelastometry show a hypercoagulable state, while conventional coagulation tests remain normal.
Authors: Robert L Ball; John W Keyloun; Kathleen Brummel-Ziedins; Thomas Orfeo; Tina L Palmieri; Laura S Johnson; Lauren T Moffatt; Anthony E Pusateri; Jeffrey W Shupp Journal: Shock Date: 2020-08 Impact factor: 3.533
Authors: Avalene W K Tan; Ronald H L Li; Yu Ueda; Joshua A Stern; Mehrab Hussain; Satoshi Haginoya; Ashely N Sharpe; Catherine T Gunther-Harrington; Steven E Epstein; Nghi Nguyen Journal: Front Vet Sci Date: 2022-07-14
Authors: Liam D Cato; Benjamin Bailiff; Joshua Price; Christos Ermogeneous; Jon Hazeldine; William Lester; Gillian Lowe; Christopher Wearn; Jonathan R B Bishop; Janet M Lord; Naiem Moiemen; Paul Harrison Journal: Burns Trauma Date: 2021-10-20