![]() The tools that allow clinicians to recognize BIC and initiate clinical interventions are also be discussed. In this review, we examine the history of BIC research, and discuss the current understanding of potential biochemical mechanisms underlying BIC in the contexts of the initial response to injury, the acute care provided during large-volume resuscitation, the recovery during a prolonged hospital stay, and long after discharge. While the extent of research in the burn population has lagged in comparison with other types of trauma, a growing body of knowledge elucidates many unique characteristics of BIC. In the past few decades, impressive advances have been made in the understanding of coagulopathy following blunt and penetrating trauma resulting in promising clinical interventions to diagnose, prevent, and treat trauma induced coagulopathy (TIC) ( 1– 5). Age, gender, race, pre-existing conditions, and concomitant injuries may play a role in the physiologic response to thermal injury, and must be considered when treating BIC. Underlying these external forces, patient-specific characteristics must be continually recognized. After discharge, patients may encounter events that could trigger coagulopathy, such as incomplete wound healing, surgical reconstructions, and impaired mobility. The development of infection or sepsis remains a leading cause of mortality for severely-burned patients, and the physiologic stress of this event can precipitate coagulopathy. ![]() The coagulation status of patients who survive the acute phase is impacted during recovery by a battery of forces. After stabilization, hemostasis is altered by care that may include blood product transfusion, extensive excision and grafting, and other surgical interventions. During transport and initial hospital care, patients are subjected to lifesaving measures including large volume resuscitation and surgical interventions that further influence coagulation. The inflammatory mechanism initiated by the injury itself has profound effects that impact clot formation and can lead to burn induced coagulopathy (BIC). ![]() A simplified schematic illustrating a patient's hospital course after burn injury.Īt each of these phases, internal and external forces impact coagulation homeostasis. ![]()
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