Burn-Induced Coagulopathies: a Comprehensive Review

doi:10.1097/SHK.0000000000001484

Review

. 2020 Aug;54(2):154-167.

doi: 10.1097/SHK.0000000000001484.

Burn-Induced Coagulopathies: a Comprehensive Review

Robert L Ball^{1

2}, John W Keyloun^{1

2

3}, Kathleen Brummel-Ziedins⁴, Thomas Orfeo⁴, Tina L Palmieri⁵, Laura S Johnson^{1

2

3}, Lauren T Moffatt^{1

2}, Anthony E Pusateri⁶, Jeffrey W Shupp^{1

2

3}

Affiliations

¹ The Burn Center, MedStar Washington Hospital Center, Washington, Dist of Columbia.
² Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, Dist of Columbia.
³ Department of Surgery, Georgetown University School of Medicine, Washington, Dist of Columbia.
⁴ Department of Biochemistry, College of Medicine, University of Vermont, Colchester, Vermont.
⁵ Department of Surgery, University of California, Davis, Regional Burn Center, Davis, California.
⁶ U.S. Army Institute of Surgical Research, JBSA, Fort Same Houston, Texas.

PMID: 31804296
PMCID: PMC7439938
DOI: 10.1097/SHK.0000000000001484

Review

Burn-Induced Coagulopathies: a Comprehensive Review

Robert L Ball et al. Shock. 2020 Aug.

. 2020 Aug;54(2):154-167.

doi: 10.1097/SHK.0000000000001484.

Authors

Affiliations

¹ The Burn Center, MedStar Washington Hospital Center, Washington, Dist of Columbia.
² Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, Dist of Columbia.
³ Department of Surgery, Georgetown University School of Medicine, Washington, Dist of Columbia.
⁴ Department of Biochemistry, College of Medicine, University of Vermont, Colchester, Vermont.
⁵ Department of Surgery, University of California, Davis, Regional Burn Center, Davis, California.
⁶ U.S. Army Institute of Surgical Research, JBSA, Fort Same Houston, Texas.

PMID: 31804296
PMCID: PMC7439938
DOI: 10.1097/SHK.0000000000001484

Abstract

Burn-induced coagulopathy is not well understood, and consensus on diagnosis, prevention, and treatments are lacking. In this review, literature on burn-induced (and associated) coagulopathy is presented along with the current understanding of the effects of burn injury on the interactions among coagulation, fibrinolysis, and inflammation in the acute resuscitative phase and reconstructive phase of care. The role of conventional tests of coagulopathy and functional assays like thromboelastography or thromboelastometry will also be discussed. Finally, reported methods for the prevention and treatment of complications related to burn-induced coagulopathy will be reviewed.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

Figures

**Fig. 1**
A simplified schematic illustrating a patient's hospital course after burn injury.

**Fig. 2**
Pathways to thrombin generation: *Extrinsic pathway:* Extravascular TF, exposed as a result of vascular injury, forms a complex with circulating FVIIa forming the extrinsic tenase (“1”) which activates FIX and FX.

**Fig. 3**
Pathways linking fibrin formation and fibrinolysis.

See this image and copyright information in PMC

Cited by

Oral propranolol and topical timolol in the treatment of post-burn pyogenic granuloma: Two cases and a review of the literature.
Ebrahimi Z, Mahdi Z, Khairi AA, Behrangi E, Zare AG, Dehghani A, Goodarzi A. Ebrahimi Z, et al. Clin Case Rep. 2022 Nov 23;10(11):e6538. doi: 10.1002/ccr3.6538. eCollection 2022 Nov. Clin Case Rep. 2022. PMID: 36439384 Free PMC article.
The Utilisation of INR to identify coagulopathy in burn patients.
Wermine K, Song J, Gotewal S, Huang L, Corona K, Bagby S, Villarreal E, Chokshi S, Efejuku T, Chaij J, Joglar A, Iglesias NJ, Keys P, De La Tejera G, Golovko G, El Ayadi A, Wolf SE. Wermine K, et al. PLoS One. 2024 Feb 23;19(2):e0278658. doi: 10.1371/journal.pone.0278658. eCollection 2024. PLoS One. 2024. PMID: 38394094 Free PMC article.
To bleed or not to bleed? Case series and discussion of haemorrhage risk with enzymatic debridement in burn injuries.
Hasham S, Riyat H, Fletcher A, O'Boyle CP, Alexander S. Hasham S, et al. Scars Burn Heal. 2023 Apr 25;9:20595131231168333. doi: 10.1177/20595131231168333. eCollection 2023 Jan-Dec. Scars Burn Heal. 2023. PMID: 37124159 Free PMC article.
Diagnostic and Prognostic Value of Thrombocytopenia in Severe Burn Injuries.
Bordeanu-Diaconescu EM, Grosu-Bularda A, Frunza A, Grama S, Andrei MC, Neagu TP, Lascar I, Hariga CS. Bordeanu-Diaconescu EM, et al. Diagnostics (Basel). 2024 Mar 9;14(6):582. doi: 10.3390/diagnostics14060582. Diagnostics (Basel). 2024. PMID: 38535003 Free PMC article.
[Paying more attention to burn induced coagulopathy].
Luo GX, Zhang QR, Qian W, Li HS. Luo GX, et al. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2023 May 20;39(5):401-406. doi: 10.3760/cma.j.cn501225-20221223-00545. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2023. PMID: 37805747 Free PMC article. Chinese.

See all "Cited by" articles

References

1. Chang R, Cardenas JC, Wade CE, Holcomb JB. Advances in the understanding of trauma-induced coagulopathy. Blood 128:1043–1049, 2016. - PMC - PubMed
1. Kornblith LZ, Moore HB, Cohen MJ. Trauma-induced coagulopathy: the past, present, and future. J Thromb Haemost 17:852–862, 2019. - PMC - PubMed
1. Stensballe J, Henriksen HH, Johansson PI. Early haemorrhage control and management of trauma-induced coagulopathy: the importance of goal-directed therapy. Curr Opin Crit Care 23:503–510, 2017. - PubMed
1. Shupp JW, Brummel-Ziedins KE, Cohen MJ, Freeman K, Hammamieh R, Mudunuri US, Orfeo T, Moffatt LT, Brownstein BH, Mann KG, et al. Military supplement: assessment of coagulation homeostasis in blunt, penetrating, and thermal trauma: guidance for a multi-center systems biology approach. Shock 52: 1S Suppl 1: 84–91, 2019. - PMC - PubMed
1. Zeeshan M, Hamidi M, Kulvatunyou N, Jehan F, O’Keeffe T, Khan M, Rashdan L, Tang A, Zakaria E-R, Joseph B. 3-factor versus 4-factor pcc in coagulopathy of trauma: four is better than three. Shock 52:23–28, 2019. - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

[1] Chang R, Cardenas JC, Wade CE, Holcomb JB. Advances in the understanding of trauma-induced coagulopathy. Blood 128:1043–1049, 2016. - PMC - PubMed

[2] Chang R, Cardenas JC, Wade CE, Holcomb JB. Advances in the understanding of trauma-induced coagulopathy. Blood 128:1043–1049, 2016. - PMC - PubMed

[3] Kornblith LZ, Moore HB, Cohen MJ. Trauma-induced coagulopathy: the past, present, and future. J Thromb Haemost 17:852–862, 2019. - PMC - PubMed

[4] Kornblith LZ, Moore HB, Cohen MJ. Trauma-induced coagulopathy: the past, present, and future. J Thromb Haemost 17:852–862, 2019. - PMC - PubMed

[5] Stensballe J, Henriksen HH, Johansson PI. Early haemorrhage control and management of trauma-induced coagulopathy: the importance of goal-directed therapy. Curr Opin Crit Care 23:503–510, 2017. - PubMed

[6] Stensballe J, Henriksen HH, Johansson PI. Early haemorrhage control and management of trauma-induced coagulopathy: the importance of goal-directed therapy. Curr Opin Crit Care 23:503–510, 2017. - PubMed

[7] Shupp JW, Brummel-Ziedins KE, Cohen MJ, Freeman K, Hammamieh R, Mudunuri US, Orfeo T, Moffatt LT, Brownstein BH, Mann KG, et al. Military supplement: assessment of coagulation homeostasis in blunt, penetrating, and thermal trauma: guidance for a multi-center systems biology approach. Shock 52: 1S Suppl 1: 84–91, 2019. - PMC - PubMed

[8] Shupp JW, Brummel-Ziedins KE, Cohen MJ, Freeman K, Hammamieh R, Mudunuri US, Orfeo T, Moffatt LT, Brownstein BH, Mann KG, et al. Military supplement: assessment of coagulation homeostasis in blunt, penetrating, and thermal trauma: guidance for a multi-center systems biology approach. Shock 52: 1S Suppl 1: 84–91, 2019. - PMC - PubMed

[9] Zeeshan M, Hamidi M, Kulvatunyou N, Jehan F, O’Keeffe T, Khan M, Rashdan L, Tang A, Zakaria E-R, Joseph B. 3-factor versus 4-factor pcc in coagulopathy of trauma: four is better than three. Shock 52:23–28, 2019. - PubMed

[10] Zeeshan M, Hamidi M, Kulvatunyou N, Jehan F, O’Keeffe T, Khan M, Rashdan L, Tang A, Zakaria E-R, Joseph B. 3-factor versus 4-factor pcc in coagulopathy of trauma: four is better than three. Shock 52:23–28, 2019. - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Burn-Induced Coagulopathies: a Comprehensive Review

Affiliations

Burn-Induced Coagulopathies: a Comprehensive Review

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical