STAGE-BY-STAGE COURSE OF DIC (DISSEMINATED INTRAVASCULAR COAGULATION) IN SEVERE BURNS AND JUSTIFICATION OF EARLY DIAGNOSIS AND DIFFERENTIAL THERAPY BASED ON HEMOSTASIS INDICES

Abstract

Under conditions of severe burn injury, the hemostatic system extends beyond the classical triad of “coagulation–anticoagulation–fibrinolysis” and evolves into a complex, dynamic, and stage-dependent coagulation phenotype that is integrally coupled with endothelial injury, systemic inflammatory response, and elements of immunothrombosis; in clinical practice, this state most often begins with hypercoagulability and microcirculatory microthrombosis, subsequently progresses to consumptive coagulopathy and an increased bleeding risk on the background of thrombocytopenia, and ultimately transitions into a form of “overt DIC” characterized by organ dysfunction. [1–3] The DIC scoring approach proposed by the ISTH (based on global coagulation tests) has practical value in severe burns as well, owing to its association with clinical observation and prognosis, and it serves as an important support particularly for dynamic assessment of laboratory indices and for stage-adapted differential planning of intensive therapy. [5,7] At the same time, in recent years, the sensitivity and clinical utility of viscoelastic hemostasis tests (TEG/ROTEM) for early detection of burn-associated coagulopathy and for guiding transfusion decisions have been increasingly emphasized, because, compared with plasma-based tests, they may detect both hypercoagulability and shifts toward fibrinolysis more rapidly. [9–11] In this literature review, the stage-specific pathophysiology of DIC in severe burns, interpretation of ISTH scoring and laboratory markers, as well as the clinical rationale for stage-adapted differential therapy (etiologic control, resuscitation, anticoagulation, component-based transfusion therapy, and optimization of surgical timing) are systematically presented. [2–4,7]