[Alteration in coagulation and fibrinolysis after burn injury and significance of anticoagulation therapy using heparin and antithrombin III concentrate].

Burn injury causes dynamic alterations in the coagulation and fibrinolysis, and so-called DIC often occurs in burned patients. In this study the clinical significance of heparin therapy combined with antithrombin III concentrate in animal experiments and clinical experiences were discussed. The changes in blood coagulation, fibrinolysis and kidney function and the effect of anticoagulation therapy using heparin were investigated in rabbits with third degree burn covering 35% of the total body surface area. The animals were subjected to determinations for various kidney function tests, blood coagulation and fibrinolysis tests, blood viscosity and hematocrit value before induction of the burn and after 8 and 24 hours respectively. Thirty rabbits were divided into a non-therapy group, an intravenous infusion group, a heparin group, an antithrombin III group, and an antithrombin III plus heparin group and the results were compared among them. Oliguria and a disturbance of kidney function were noted even at hour 8 after burn in the non-therapy group. In the intravenous infusion group urine volume was maintained well although the early stage of non-oliguric renal insufficiency was noted. The changes noted in the intravenous infusion group were prevented almost completely in the heparin group at hour 8, but FENa and CH2O were elevated at hour 24 probably because antithrombin III activity was depressed markedly. In the antithrombin III group and the antithrombin III plus heparin group, however, creatinine clearance was moderately elevated while FENa and CH2O remained unchanged as compared with the values before the burn. The antithrombin III plus heparin group showed slightly better results than the antithrombin III group in Ucr/Pcr ratio, creatinine clearance and CH2O. The results of the present study indicate that it is extremely effective to initiate appropriate fluid infusion therapy immediately after a burn and administer antithrombin III concentrate in combination with or without heparin for the prevention of acute renal insufficiency in patient with a severe burn. The effects of antithrombin III concentrate when used clinically were also discussed.