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Thrombin generation in patients with severe thermal injury.

Authors
  • Wiegele, Marion1
  • Schaden, Eva2
  • Koch, Stefan3
  • Bauer, Daniel4
  • Krall, Christoph5
  • Adelmann, Dieter6
  • 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: [email protected] , (Austria)
  • 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: [email protected] , (Austria)
  • 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: [email protected] , (Austria)
  • 4 Department of Anaesthesiology and Intensive Care Medicine, Landeskrankenhaus Steyr, Sierninger Straße 170, 4400 Steyr, Austria. Electronic address: [email protected] , (Austria)
  • 5 Center for Medical Statistics, Informatics and Intelligent Systems, Section of Medical Statistics, Medical University of Vienna, Spitalgasse 23, 1090 Wien, Austria. Electronic address: [email protected] , (Austria)
  • 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: [email protected] , (Austria)
Type
Published Article
Journal
Burns : journal of the International Society for Burn Injuries
Publication Date
Feb 01, 2019
Volume
45
Issue
1
Pages
54–62
Identifiers
DOI: 10.1016/j.burns.2018.09.020
PMID: 30327230
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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). 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. 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. Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.

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