Degree of hypercoagulability and hyperfibrinolysis is related to organ failure and prognosis after burn trauma.
Severely burned patients often present a hypercoagulability situation. However, its magnitude, time course, and relationship with organ failure and outcome remains to be established. Forty-three patients were studied on the first and seventh day after burn for hypercoagulability and fibrinolysis parameters. A hypercoagulability and hyperfibrinolysis state was found the first day after burn demonstrated by high levels of activated factor VII (VIIa, p<0.01), thrombin-antithrombin III complex (TAT, p<0.01), tissue plasminogen activator (t-PA, p<0.001) and D dimer (DD, p<0.01) and low levels of antithrombin III (ATIII, p<0.01), protein C (PC, p<0.01), plasminogen (PG, p<0.001) and alpha2 antiplasmin (AP, p<0.001). A paradoxical coexisting hypofibrinolysis was found as suggested by a low global fibrinolytic activity in the euglobulin plasma fraction fibrin plate assay (FA, p<0.01) and high levels of tissue plasminogen activator inhibitor type 1 (PAI-1, p<0.01). On day 7, a less marked hypercoagulability situation was found, with low ATIII (p<0.01) and PC (p<0.01), persisting the hypofibrinolytic situation observed on the first day. Non-survivors (NS) showed higher levels of VIIa (p<0.01), TAT (p<0.05) and t-PA (p<0.05), and lower levels of ATIII (p<0.05), PC (p<0.05) and AP (p<0.001) than survivors (S) on the first day. Also, there was a positive correlation of Marshall organ failure score with ATIII, (r2=0.49, p<0.001), PC, (r2=0.14, p<0.045) and PG levels, (r2=0.41, p<0.0003). Severely burned patients show a state of transient disseminated intravascular coagulation, related to the development of organ failure and outcome.
García-Avello
A
A
Hematology Department, Hospital Ramón y Cajal, Madrid, Spain.
Lorente
J A
JA
Cesar-Perez
J
J
García-Frade
L J
LJ
Alvarado
R
R
Arévalo
J M
JM
Navarro
J L
JL
Esteban
A
A
D000328:Adult; D000941:Antigens / Q000378:metabolism; D000990:Antithrombin III / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D001779:Blood Coagulation Factors / Q000378:metabolism*; D002056:Burns / Q000097:blood* / Q000150:complications; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000150:complications; D005167:Factor VII / Q000378:metabolism; D015942:Factor VIIa / Q000378:metabolism; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005342:Fibrinolysis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood* / Q000209:etiology; D010447:Peptide Hydrolases / Q000378:metabolism; D011486:Protein C / Q000378:metabolism
D000941:Antigens; D015415:Biomarkers; D001779:Blood Coagulation Factors; D005338:Fibrin Fibrinogen Degradation Products; D011486:Protein C; C046193:antithrombin III-protease complex; C042580:factor VII clotting antigen; C036309:fibrin fragment D; D000990:Antithrombin III; D005167:Factor VII; D010447:Peptide Hydrolases; D015942:Factor VIIa