Measuring coagulation in burns: an evidence-based systematic review.

Autor:	Marsden NJ; NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK.; Welsh Centre for Burns and Plastic Surgery, Swansea, UK., Van M; Welsh Centre for Burns and Plastic Surgery, Swansea, UK., Dean S; Welsh Centre for Burns and Plastic Surgery, Swansea, UK., Azzopardi EA; Welsh Centre for Burns and Plastic Surgery, Swansea, UK.; Reconstructive Surgery and Regenerative Medicine Group, Institute of Life Science, College of Medicine, Swansea University, Wales, UK., Hemington-Gorse S; Welsh Centre for Burns and Plastic Surgery, Swansea, UK., Evans PA; NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, UK.; Reconstructive Surgery and Regenerative Medicine Group, Institute of Life Science, College of Medicine, Swansea University, Wales, UK., Whitaker IS; Welsh Centre for Burns and Plastic Surgery, Swansea, UK.; Reconstructive Surgery and Regenerative Medicine Group, Institute of Life Science, College of Medicine, Swansea University, Wales, UK.
Jazyk:	angličtina
Zdroj:	Scars, burns & healing [Scars Burn Heal] 2017 Sep 05; Vol. 3, pp. 2059513117728201. Date of Electronic Publication: 2017 Sep 05 (Print Publication: 2017).
DOI:	10.1177/2059513117728201
Abstrakt:	Introduction: Dynamic monitoring of coagulation is important to predict both haemorrhagic and thrombotic complications and to guide blood product administration. Reducing blood loss and tailoring blood product administration may improve patient outcome and reduce mortality associated with transfusion. The current literature lacks a systematic, critical appraisal of current best evidence on which clinical decisions may be based. Objectives: Establishing the role of different coagulation markers in burn patients, diagnosing coagulopathy, tailoring blood product administration and indicating prognosis. Methods: Literature during 2004-2017 from the Cochrane Library, PubMed, Scopus, Medline and Embase was reviewed. Eligibility criteria included randomised controlled trials, systematic reviews, multi-/single-centre study and meta-analyses. Keywords searched were 'burns', 'blood coagulation disorders', 'rotem', 'blood coagulation' and 'thromboelastography'. The PRISMA flow system was used for stratification and the CASP framework for appraisal of the studies retrieved. Results: In total, 13 articles were included after inclusion/exclusion criteria had been applied to the initial 79 studies retrieved. Hypercoagulation increases in proportion to the severity of thermal injury. Whole blood testing, using thrombelastography (TEG) and rotation thromboelastometry (ROTEM), was superior to standard plasma based tests, including prothrombin time (PT) and activated partial thromboplastin time (APTT) at detecting burn-related coagulopathies. Conclusions: Routine laboratory markers such as PT/APTT are poor indicators of coagulation status in burns patients. Viscoelastic tests, such as TEG and ROTEM, are efficient, fast and have a potential use in the management of burn patients; however, strong evidence is lacking. This review highlights the need for more randomised controlled trials, to guide future practice. Competing Interests: Declaration of conflicting interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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