# It Is Written in the Clot: Coagulation Assessment in Severe Burn Injury

## TL;DR

This study compares different coagulation tests in severe burn patients and finds that viscoelastic assays are more effective than traditional tests in predicting coagulopathy and mortality risk.

## Contribution

The study demonstrates that viscoelastic coagulation assays (VCAs) are more sensitive than conventional coagulation assays in detecting coagulopathy in severe burn patients.

## Key findings

- Conventional coagulation assays (CCAs) failed to detect coagulopathy in severe burn patients.
- Viscoelastic coagulation assays (VCAs) showed increased FIBTEM MCF values in non-survivors from day 2 onwards.
- Abnormal VCAs parameters at day 2 and day 5 correlated with higher mortality risk in burn patients.

## Abstract

Background: Coagulopathy in severe burn injury is associated with complications and mortality. Methods: We compared 3 tests (EXTEM, INTEM, FIBTEM) of rotational thromboelastometry (ROTEM), a viscoelastic coagulation assay (VCA), with conventional coagulation assays (CCAs), fibrinogen, d-dimers and coagulation factors during the five post-burn days in survivors and non-survivors with severe burn injury, in order to correlate the results with burn coagulopathy and prognosis. Results: Seventeen survivors and ten non-survivors, with mean total burn surface area of 33.78% were included. CCAs measurements were abnormal, but unable to detect coagulopathy. At day 2, D-dimers and fibrinogen levels were statistically augmented for non-survivors. Regarding VCAs, FIBTEM MCF increased for non-survivors at day 2 and remained increased for the whole post-burn period. Furthermore, FIBTEM A10 and A20 at day 2 and EXTEM A10, EXTEM A20, EXTEM MCF, and EXTEM CFT at day 5 took abnormal values for the same group (p < 0.05). These changes were underlined through abnormal measurements of coagulation factors. Conclusions:CCAs are poor indicators of coagulation status in burn injury, whereas VCAs are more sensitive markers, demonstrating coagulopathy and patients at greater risk of mortality.