Wiegele Marion, Kozek-Langenecker Sibylle, Schaden Eva
Division of General Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.
Department of Anaesthesia and Intensive Care, Evangelical Hospital Vienna, Vienna, Austria.
Semin Thromb Hemost. 2017 Jun;43(4):433-438. doi: 10.1055/s-0037-1599155. Epub 2017 Mar 30.
Severe burn injury has an impact on the coagulation system, but a unique definition regarding these changes is still missing. The results of conventional coagulation assays (CCAs) measured in daily clinical practice are often interpreted as coagulopathic, which implies a bleeding tendency. However, viscoelastic coagulation assays (VCA) like Rotational Thromboelastometry (ROTEM) and Thromboelastography (TEG) depict a hypercoagulable state. Therefore, hemostatic interventions should not be indicated according to deranged CCA results, but only in case of clinically relevant bleeding plus indicative VCA results. Massive blood loss mainly results from surgical excision of burn wounds. VCAs seem to be capable of guiding target-oriented coagulation management in this context. Owing to the increased thromboembolic risk, it appears rational to individualize pharmacologic venous thromboembolism prophylaxis by using sensitive laboratory tests and drug monitoring. Studies evaluating the use of new VCA test modifications are highly warranted and may substantially improve outcome in this difficult-to-treat patient population.
严重烧伤会影响凝血系统，但对于这些变化仍缺乏一个明确的定义。在日常临床实践中测量的传统凝血检测（CCA）结果通常被解释为凝血病，这意味着有出血倾向。然而，诸如旋转血栓弹力图（ROTEM）和血栓弹力图（TEG）等黏弹性凝血检测（VCA）显示为高凝状态。因此，不应根据异常的CCA结果进行止血干预，而仅应在存在临床相关出血且VCA结果有指示意义时进行干预。大量失血主要源于烧伤创面的手术切除。在这种情况下，VCA似乎能够指导目标导向的凝血管理。由于血栓栓塞风险增加，通过使用敏感的实验室检测和药物监测来个体化药物性静脉血栓栓塞预防似乎是合理的。非常有必要开展评估新型VCA检测改良方法应用的研究，这可能会显著改善这类难治性患者群体的治疗结局。
