Background: Severe burns cause profound hemostasis. An objective assessment of the state of the hemostatic system is the key to effective treatment of patients.

Aims: To study the relationship of thromboelastogram indices with generally accepted coagulological tests in patients with severe burn injury.

Methods: The state of the endothelial, coagulation, anticoagulant and fibrinolytic links of the hemostatic system (ACL TOP 500 analyzer), the viscoelastic properties of the blood (thromboelastograph TEG 500, tests using a coaline activator and heparinase), were determined in 233 patients with burns over 20% of the body surface and in 20 healthy people.

Results: The studies have shown that the hemostatic system reacts with a sharp increase in procoagulant activity, endothelial dysfunction, oppression of anticoagulant mechanisms as a response to severe thermal damage. The highest sensitivity was revealed to the following tests: von Willebrand factor (FW) activity was 100%, XIIa-dependent fibrinolysis (XIIa-df) – 95%, fibrinogen (Fg) – 72%, antithrombin III (AT III) – 65%, TEG (alpha, MA and G) – 44%, APTT, thrombin time, prothrombin time, TEG (R and k) – less than 20%. Analysis of the correlation between TEG indices and standard coagulogram tests revealed a moderate relationship between APTT and R (r = 0.42, p = 0.001), Fg and MA (r = 0.47, p = 0.001), Fg and G (r = 0.48, p = 0.001). There was no correlation with FW, ATIII, XIIa- df.

Conclusions: Thromboelastography is not an alternative to advanced coagulological studies. At the same time, it is an indispensable tool for verifying the cause of hypocoagulation in patients with severe burn injury.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/possibilities-of-thromboelastography-in-patients-with-severe-burns/