Early coagulation disorders after severe burn injury: impact on mortality

Lavrentieva, Athina; Kontakiotis, Theodoros; Bitzani, Militsa; Papaioannou-Gaki, Georgia; Parlapani, A.; Thomareis, O; Tsotsolis, Nicolaos; Giala, M.

doi:10.1007/s00134-007-0976-5

Cited by 102 publications

(113 citation statements)

References 28 publications

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“…Burn-induced sepsis results in a much poorer outcome due to multiple organ failure caused by both overwhelming coagulation and inflammation 29,37,38 . Therefore, the normalization of coagulation system and improvement of systemic inflammation are essential to treat severe burn.…”

Section: Discussionmentioning

confidence: 99%

Haptoglobin Reduces Inflammatory Cytokine INF-γ and Facilitates Clot Formation in Acute Severe Burn Rat Model

et al. 2017

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Haptoglobin exerts renal protective function by scavenging free hemoglobin from the urine and blood stream in patients with hemolytic disorders. Recent studies elucidate the relationships between haptoglobin and inflammation. In addition, coagulopathy is often induced by systemic inflammation characterized by the presence of vascular endothelial damage. We hypothesize that haptoglobin might have an anti-inflammatory effect and affect hypercoagulability using rat burn model. Thirty anesthetized rats of six-weeks of age received over 30% full-thickness scald burn on the dorsal skin surface. All rats were injected with either haptoglobin (Hpt) or normal saline (NS) intraperitoneally. The rats were divided into three groups: 1) control group (NS 20 mL/kg); 2) low concentration of Hpt group, L-Hpt, (Hpt 4 mL (80 U)/kg+NS 16 mL/kg); and 3) high concentration of Hpt group, H-Hpt, (Hpt 20 mL (400 U)/kg).While under anesthesia, all rats were euthanized by exsanguination at 6 hours (N=5) and 24 hours (N= 5). Inflammatory and anti-inflammatory cytokines were measured and whole-blood viscoelastic tests were performed by thromboelastometry (ROTEM). Haptoglobin significantly reduced free hemoglobin 24 hours after the injury. Improvement of hematuria was confirmed in the H-Hpt group. There were no differences in thrombin-antithrombin complex and plasmin-α2 plasmin inhibitor complex. The haptoglobin tended to decrease interferon-gamma (IFN-γ) in H-Hpt group. ROTEM findings of the L-Hpt group showed significantly higher clot firmness and shorter time to maximum clot formation velocity than the control group. Haptoglobin reduced INF-γ, and accelerated speed of clot formation in acute phase of severe burn. (J Nippon Med Sch 2017; 84: 64 72)

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Section: Discussionmentioning

confidence: 99%

Haptoglobin Reduces Inflammatory Cytokine INF-γ and Facilitates Clot Formation in Acute Severe Burn Rat Model

et al. 2017

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“…These abnormalities caused an increased state of fibrinolysis and thrombogenicity in the patients, which was confirmed by specific markers of activation such as D-dimer, TAT complex, plasminogen activator inhibitor-1, and tissue plasminogen activator [35,47] . The DIC pathophysiology initiates coagulation and fibrinolysis through endothelial cells or tissue injury, with release of cytokines and other acute phase reactants.…”

Section: Dicmentioning

confidence: 95%

“…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%

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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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“…The impact on mortality of early coagulation disorders after severe burn injury was addressed by Lavrentieva et al [51]. In this single centre prospective study conducted on 45 patients with severe thermal burn injury the 28-day mortality rate was 33%.…”

Section: Outcome Research and Critical Care Organizationmentioning

confidence: 97%

Year in review in Intensive Care Medicine, 2008: III. Paediatrics, Ethics, outcome research and critical care organization, sedation, pharmacology and miscellanea

et al. 2009

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Early coagulation disorders after severe burn injury: impact on mortality

Abstract: Severe thermal injury is associated with the early activation of coagulation cascade, presence of DIC, organ failure, and increased mortality.

Cited by 102 publications

References 28 publications

Haptoglobin Reduces Inflammatory Cytokine INF-γ and Facilitates Clot Formation in Acute Severe Burn Rat Model

Haptoglobin Reduces Inflammatory Cytokine INF-γ and Facilitates Clot Formation in Acute Severe Burn Rat Model

Antithrombin in the treatment of burn trauma

Year in review in Intensive Care Medicine, 2008: III. Paediatrics, Ethics, outcome research and critical care organization, sedation, pharmacology and miscellanea

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