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Measuring coagulation in burns: an evidence-based systematic review
Nicholas J Marsden1,2, Martin Van2, Samera Dean2
1NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK.
Scars, Burns & Healing
|May 26, 2018
Summary
Dynamic coagulation monitoring is crucial for burn patients. Viscoelastic tests like thrombelastography (TEG) and rotation thromboelastometry (ROTEM) show promise over traditional tests for managing coagulopathy.
Area of Science:
- Critical care medicine
- Trauma surgery
- Laboratory hematology
Background:
- Dynamic coagulation monitoring aids in predicting and managing hemorrhagic/thrombotic complications in burn patients.
- Tailoring blood product administration can improve patient outcomes and reduce transfusion-related mortality.
- A systematic appraisal of current evidence guiding clinical decisions in burn coagulopathy is lacking.
Purpose of the Study:
- To establish the role of coagulation markers in burn patients.
- To diagnose coagulopathy and guide blood product administration.
- To indicate prognosis in burn patients with coagulation disorders.
Main Methods:
- A systematic literature review was conducted from 2004-2017.
- Databases searched included Cochrane Library, PubMed, Scopus, Medline, and Embase.
- Keywords focused on burns, coagulation disorders, TEG, and ROTEM; PRISMA and CASP frameworks were utilized.
Main Results:
- Thirteen articles were included, revealing hypercoagulation increases with burn severity.
- Whole blood viscoelastic tests (TEG/ROTEM) outperformed standard plasma tests (PT/APTT) in detecting burn-related coagulopathies.
- Standard tests like PT/APTT are poor indicators of coagulation status in burn patients.
Conclusions:
- Viscoelastic tests (TEG/ROTEM) are efficient and fast for managing burn patients.
- Strong evidence supporting their routine use is currently lacking.
- Further randomized controlled trials are needed to guide clinical practice.
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