Semin Thromb Hemost 2015; 41(01): 043-048
DOI: 10.1055/s-0034-1398380
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hypercoagulability and Venous Thromboembolism in Burn Patients

Jonathan P. Meizoso
1   Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
,
Juliet J. Ray
1   Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
,
Casey J. Allen
1   Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
,
Robert M. Van Haren
1   Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
,
Gabriel Ruiz
1   Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
,
Nicholas Namias
1   Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
,
Carl I. Schulman
1   Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
,
Louis R. Pizano
1   Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
,
Kenneth G. Proctor
1   Divisions of Trauma, Surgical Critical Care, and Burns at the Ryder Trauma Center, The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
› Author Affiliations
Further Information

Publication History

Publication Date:
15 January 2015 (online)

Abstract

To our knowledge, this is the first comprehensive review on the subject of venous thromboembolism (VTE) and hypercoagulability in burn patients. Specific changes in coagulability are reviewed using data from thromboelastography and other techniques. Disseminated intravascular coagulation in burn patients is discussed. The incidence and risk factors associated with VTE in burn patients are then examined, followed by the use of low-molecular-weight heparin thromboprophylaxis and monitoring techniques using antifactor Xa levels. The need for large, prospective trials in burn patients is highlighted, especially in the areas of VTE incidence and safe, effective thromboprophylaxis.

 
  • References

  • 1 Pannucci CJ, Osborne NH, Park HS, Wahl WL. Acquired inpatient risk factors for venous thromboembolism after thermal injury. J Burn Care Res 2012; 33 (1) 84-88
  • 2 Pannucci CJ, Osborne NH, Wahl WL. Venous thromboembolism in thermally injured patients: analysis of the National Burn Repository. J Burn Care Res 2011; 32 (1) 6-12
  • 3 Pannucci CJ, Osborne NH, Wahl WL. Creation and validation of a simple venous thromboembolism risk scoring tool for thermally injured patients: analysis of the National Burn Repository. J Burn Care Res 2012; 33 (1) 20-25
  • 4 Mullins F, Mian MA, Jenkins D , et al. Thromboembolic complications in burn patients and associated risk factors. J Burn Care Res 2013; 34 (3) 355-360
  • 5 Fecher AM, O'Mara MS, Goldfarb IW , et al. Analysis of deep vein thrombosis in burn patients. Burns 2004; 30 (6) 591-593
  • 6 Wibbenmeyer LA, Hoballah JJ, Amelon MJ , et al. The prevalence of venous thromboembolism of the lower extremity among thermally injured patients determined by duplex sonography. J Trauma 2003; 55 (6) 1162-1167
  • 7 Sheridan RL, Rue III LW, McManus WF, Pruitt Jr BA. Burns in morbidly obese patients. J Trauma 1992; 33 (6) 818-820
  • 8 Wait M, Hunt JL, Purdue GF. Duplex scanning of central vascular access sites in burn patients. Ann Surg 1990; 211 (4) 499-503
  • 9 García-Avello A, Lorente JA, Cesar-Perez J , et al. Degree of hypercoagulability and hyperfibrinolysis is related to organ failure and prognosis after burn trauma. Thromb Res 1998; 89 (2) 59-64
  • 10 Aoki K, Aikawa N, Sekine K , et al. Elevation of plasma free PAI-1 levels as an integrated endothelial response to severe burns. Burns 2001; 27 (6) 569-575
  • 11 Barret JP, Gomez PA. Disseminated intravascular coagulation: a rare entity in burn injury. Burns 2005; 31 (3) 354-357
  • 12 Barret JP, Dziewulski PG. Complications of the hypercoagulable status in burn injury. Burns 2006; 32 (8) 1005-1008
  • 13 Lavrentieva A, Kontakiotis T, Bitzani M , et al. Early coagulation disorders after severe burn injury: impact on mortality. Intensive Care Med 2008; 34 (4) 700-706
  • 14 King DR, Namias N, Andrews DM. Coagulation abnormalities following thermal injury. Blood Coagul Fibrinolysis 2010; 21 (7) 666-669
  • 15 Lippi G, Ippolito L, Cervellin G. Disseminated intravascular coagulation in burn injury. Semin Thromb Hemost 2010; 36 (4) 429-436
  • 16 Van Haren RM, Thorson CM, Valle EJ , et al. Hypercoagulability after burn injury. J Trauma Acute Care Surg 2013; 75 (1) 37-43 , discussion 43
  • 17 Kowal-Vern A, Walenga JM, Hoppensteadt D, Gamelli RL. Prothrombin fragment 1.2 and modified antithrombin as predictors of disseminated intravascular coagulation and thrombotic risk in thermal injury. J Burn Care Res 2013; 34 (4) 459-464
  • 18 Alkjaersig N, Fletcher AP, Peden Jr JC, Monafo WW. Fibrinogen catabolism in burned patients. J Trauma 1980; 20 (2) 154-159
  • 19 Schaden E, Hoerburger D, Hacker S, Kraincuk P, Baron DM, Kozek-Langenecker S. Fibrinogen function after severe burn injury. Burns 2012; 38 (1) 77-82
  • 20 Niedermayr M, Schramm W, Kamolz L , et al. Antithrombin deficiency and its relationship to severe burns. Burns 2007; 33 (2) 173-178
  • 21 Lavrentieva A, Kontakiotis T, Bitzani M , et al. The efficacy of antithrombin administration in the acute phase of burn injury. Thromb Haemost 2008; 100 (2) 286-290
  • 22 Lipový B, Kaloudová Y, Matýsková M, Penka M, Rihová H, Brychta P. Hemocoagulation disorders in extensively burned patients: pilot study for scoring of the DIC. Acta Chir Plast 2008; 50 (4) 115-118
  • 23 Foley FD, Moncrief JA, Mason Jr AD. Pathology of the lung in fatally burned patints. Ann Surg 1968; 167 (2) 251-264
  • 24 Pruitt Jr BA, DiVincenti FC, Mason Jr AD, Foley FD, Flemma RJ. The occurrence and significance of pneumonia and other pulmonary complications in burned patients: comparison of conventional and topical treatments. J Trauma 1970; 10 (7) 519-531
  • 25 Haynes Jr BW. Current problems in burns. A perspective. Arch Surg 1971; 103 (4) 454-460
  • 26 Achauer BM, Allyn PA, Furnas DW, Bartlett RH. Pulmonary complications of burns: the major threat to the burn patient. Ann Surg 1973; 177 (3) 311-319
  • 27 McDowall RAW. Pulmonary embolism and deep venous thrombosis in burned patients. Br J Plast Surg 1973; 26 (2) 176-177
  • 28 Coleman JB, Chang FC. Pulmonary embolism. An unrecognized event in severely burned patients. Am J Surg 1975; 130 (6) 697-699
  • 29 Pruitt Jr BA, Erickson DR, Morris A. Progressive pulmonary insufficiency and other pulmonary complications of thermal injury. J Trauma 1975; 15 (5) 369-379
  • 30 Purdue GF, Hunt JL. Pulmonary emboli in burned patients. J Trauma 1988; 28 (2) 218-220
  • 31 Desai MH, Linares HA, Herndon DN. Pulmonary embolism in burned children. Burns 1989; 15 (6) 376-380
  • 32 Rue III LW, Cioffi Jr WG, Rush R, McManus WF, Pruitt Jr BA. Thromboembolic complications in thermally injured patients. World J Surg 1992; 16 (6) 1151-1154 , discussion 1155
  • 33 Harrington DT, Mozingo DW, Cancio L, Bird P, Jordan B, Goodwin CW. Thermally injured patients are at significant risk for thromboembolic complications. J Trauma 2001; 50 (3) 495-499
  • 34 Wahl WL, Brandt MM. Potential risk factors for deep venous thrombosis in burn patients. J Burn Care Rehabil 2001; 22 (2) 128-131
  • 35 Wahl WL, Brandt MM, Ahrns KS , et al. Venous thrombosis incidence in burn patients: preliminary results of a prospective study. J Burn Care Rehabil 2002; 23 (2) 97-102
  • 36 Chung KK, Blackbourne LH, Renz EM , et al. Global evacuation of burn patients does not increase the incidence of venous thromboembolic complications. J Trauma 2008; 65 (1) 19-24
  • 37 Pannucci CJ, Osborne NH, Jaber RM, Cederna PS, Wahl WL. Early fasciotomy in electrically injured patients as a marker for injury severity and deep venous thrombosis risk: an analysis of the National Burn Repository. J Burn Care Res 2010; 31 (6) 882-887
  • 38 Pannucci CJ, Diaz JA, Wahl WL. Temporal changes in deep venous thrombosis risk after electrical injury. J Burn Care Res 2011; 32 (3) 442-446
  • 39 Wahl WL, Brandt MM, Ahrns K, Corpron CA, Franklin GA. The utility of D-dimer levels in screening for thromboembolic complications in burn patients. J Burn Care Rehabil 2002; 23 (6) 439-443
  • 40 Ferguson REH, Critchfield A, Leclaire A, Ajkay N, Vasconez HC. Current practice of thromboprophylaxis in the burn population: a survey study of 84 US burn centers. Burns 2005; 31 (8) 964-966
  • 41 Abedi N, Papp A. A survey of current practice patterns in prophylaxis against venous thromboembolism (VTE) and gastrointestinal (GI) ulceration among Canadian burn centers. Burns 2011; 37 (7) 1182-1186
  • 42 Namias N. Advances in burn care. Curr Opin Crit Care 2007; 13 (4) 405-410
  • 43 Faucher LD, Conlon KM. Practice guidelines for deep venous thrombosis prophylaxis in burns. J Burn Care Res 2007; 28 (5) 661-663
  • 44 Clark DE, Lowman JD, Griffin RL, Matthews HM, Reiff DA. Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. Phys Ther 2013; 93 (2) 186-196
  • 45 Bushwitz J, LeClaire A, He J, Mozingo D. Clinically significant venous thromboembolic complications in burn patients receiving unfractionated heparin or enoxaparin as prophylaxis. J Burn Care Res 2011; 32 (6) 578-582
  • 46 Scott JR, Klein MB, Gernsheimer T, Honari S, Gibbons J, Gibran NS. Arterial and venous complications of heparin-induced thrombocytopenia in burn patients. J Burn Care Res 2007; 28 (1) 71-75
  • 47 Yogaratnam D, Smith BS, Angood PB, Gandhi PJ. Antifactor Xa levels in four patients with burn injuries who received enoxaparin to prevent venous thromboembolism. Pharmacotherapy 2004; 24 (12) 1793-1799
  • 48 Lin H, Faraklas I, Cochran A, Saffle J. Enoxaparin and antifactor Xa levels in acute burn patients. J Burn Care Res 2011; 32 (1) 1-5
  • 49 Lin H, Faraklas I, Saffle J, Cochran A. Enoxaparin dose adjustment is associated with low incidence of venous thromboembolic events in acute burn patients. J Trauma 2011; 71 (6) 1557-1561
  • 50 Faraklas I, Ghanem M, Brown A, Cochran A. Evaluation of an enoxaparin dosing calculator using burn size and weight. J Burn Care Res 2013; 34 (6) 621-627
  • 51 Brown A, Faraklas I, Ghanem M, Cochran A. Enoxaparin and antifactor Xa levels in pediatric acute burn patients. J Burn Care Res 2013; 34 (6) 628-632
  • 52 Cherry RA, Nichols PA, Snavely TM, David MT, Lynch FC. Prophylactic inferior vena cava filters: do they make a difference in trauma patients?. J Trauma 2008; 65 (3) 544-548
  • 53 Still J, Friedman B, Furman S , et al. Experience with the insertion of vena caval filters in acutely burned patients. Am Surg 2000; 66 (3) 277-279