gms | German Medical Science

38. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2020)

15.01. - 18.01.2020, Zell am See, Österreich

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Blood coagulation alterations over the first 10 days after severe burn injury

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  • J. Barbier - Service of Intensive Care Medicine & Burns, University of Lausanne Hospitals CHUV, Lausanne, Switzerland
  • M. V. Viana - Service of Intensive Care Medicine & Burns, University of Lausanne Hospitals CHUV, Lausanne, Switzerland
  • O. Pantet - Service of Intensive Care Medicine & Burns, University of Lausanne Hospitals CHUV, Lausanne, Switzerland
  • M. M. Berger - Service of Intensive Care Medicine & Burns, University of Lausanne Hospitals CHUV, Lausanne, Switzerland

Deutschsprachige Arbeitsgemeinschaft für Verbrennungsbehandlung. 38. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2020). Zell am See, Österreich, 15.-18.01.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. Doc7.06

doi: 10.3205/20dav047, urn:nbn:de:0183-20dav0476

Published: January 13, 2020

© 2020 Barbier et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

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Introduction: Coagulation disorders have been described in major burns patients during the first 48 hours after injury affecting mainly INR and aPTT: some authors have proposed the existence of a burn specific coagulopathy. Major burns (>20% of body surface (BSA)) require large volumes of fluid resuscitation to achieve hemodynamic stability. The relation between the volumes infused during the resuscitation and coagulation disorders is not well established. The aim of the study was to investigate the relation between the volume of fluid resuscitation and the magnitude of the coagulopathy over the first 10 days with a special focus on the first 72 hrs.

Methods: A retrospective study was conducted in patients with a ≥20 %BSA burn who stayed ≥24 hours at the Burn-ICU between 01.01.2006 and 30.06.2018. Three patient groups were stratified based on burned surface (20-40%, 41-60% and >60% BSA). Classical demographic variables were recorded, along with exact fluid volumes, and coagulation laboratory (INR (international normalized ratio), aPTT (activated partial thromboplastin time), prothrombin time (TP), platelets). The analysis of fluid administration, blood products infusion, coagulation system disturbances, their dynamic and relation was done for all patients and for each group. All data were extracted from the computer information system’s data base (MetaVision®). Results are given in median [IQR].

Results: 167 patients met the inclusion criteria: they were aged 39 [26;58], and burned with 35 [24;50] %BSA. The volumes of fluid resuscitation decrease between day 1 and day 11 (6815 vs 4190 ml). During the early phase, PT was the most frequently pathologic value and shows the strongest relation with fluid volumes (R2 = 0.124). Perturbations of PT, aPTT and INR decreased after 72 hours while the frequency and severity of thrombocytopenia increased between day 3 and day 11. No association with anomalies of liver function tests (ASAT, ALAT) was observed. Overall, only 12 patients presented combined and reiterated coagulation alterations.

Conclusion: This study does not confirm any specific burns associated coagulopathy based on pathologic INR and aPTT values. We observed a small dilution effect on PT and the development of a late thrombocytopenia. The alterations were transient and generally self-resolutive.