Coagulation abnormalities following thermal injury

Changes in coagulation may have a profound impact on outcomes following severe burns and the coagulation abnormalities after thermal injury are incompletely described. We postulated that thermal injury induces a systemic hypercoagulable state. With Institutional Review Board approval, five patients were consented for enrollment in this case series. After obtaining informed consent, blood was drawn on hospital days 1, 2, 3, 5, and 7 or until discharge if discharge was in less than 7 days. Standard coagulation testing was performed, as well as a battery of sophisticated specialized coagulation assays. Other data collected includes fluid resuscitation volumes, pharmacologic interventions, and general physiologic information. Results (n = 5) demonstrate that burns less than 6% total body surface area appear to have little effect on coagulation. Burns greater than 6% appear to induce a systemic hypercoagulable state with a phase and magnitude relationship proportional to total body surface area burned. Severe burns greater than 40% appear to induce a consumptive coagulopathy. Prothrombin fragment 1.2 may represent a useful screening test for a burn-induced hypercoagulable state.