title: Coagulopathy and its management in patients with severe burns.
abstract: Severe burn injury is associated with systemic coagulopathy. The changes in coagulation described in patients with severe burns resemble those found patients with sepsis or major trauma. Coagulopathy in patients with severe burns is characterized by procoagulant changes, and impaired fibrinolytic and natural anticoagulation systems. Both the timing of onset and the severity of hemostatic derangements are related to the severity of the burn. The exact pathophysiology and time course of coagulopathy are uncertain, but, at least in part, result from hemodilution and hypothermia. As the occurrence of coagulopathy in patients with severe burns is associated with increased comorbidity and mortality, coagulopathy could be seen as a potential therapeutic target. Clear guidelines for the treatment of coagulopathy in patients with severe burns are lacking, but supportive measures and targeted treatments have been proposed. Supportive measures are aimed at avoiding preventable triggers such as tissue hypoperfusion caused by shock, or hemodilution and hypothermia following the usually aggressive fluid resuscitation in these patients. Suggested targeted treatments that could benefit patients with severe burns include systemic treatment with anticoagulants, but sufficient randomized controlled trial evidence is lacking.
authors: Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A), Academic Medical Center, Amsterdam, the Netherlands.
authors: G J
authors: GJ
authors: Glas
authors: Department of Medicine, Academic Medical Center, Amsterdam, the Netherlands.
authors: M
authors: M
authors: Levi
authors: Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A), Academic Medical Center, Amsterdam, the Netherlands.|Department of Intensive Care, Academic Medical Center, Amsterdam, the Netherlands.
authors: M J
authors: MJ
authors: Schultz
mesh_terms: D000925:Anticoagulants / Q000737:chemistry; D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000150:complications / Q000276:immunology* / Q000628:therapy*; D002056:Burns / Q000150:complications / Q000276:immunology / Q000628:therapy*; D003029:Coagulants / Q000737:chemistry; D005342:Fibrinolysis; D006438:Hemodilution; D006487:Hemostasis; D006801:Humans; D011994:Recombinant Proteins / Q000737:chemistry; D015208:Smoke Inhalation Injury
chemical_list: D000925:Anticoagulants; D003029:Coagulants; D011994:Recombinant Proteins
keywords: anticoagulants; blood coagulation; burn; critical care; disseminated intravascular coagulation; fibrinolysis