Coronary Thrombosis following Injury and Burns

Abstract

Cases of recent coronary thrombosis, with or without myocardial infarction, are described in injured and burned subjects. Although the thrombi were associated with atheromatous disease, they cannot be set aside as being always or wholly due to natural causes because other cases with little or no coronary atheroma have been reported. Periodic thrombosis in renal arteries and other uninjured vessels strengthens the argument for a connexion between trauma and arterial thrombogenesis in some cases. The appearance of pulmonary microthrombi in most injured and burned cases and of glomerular microthrombi in some subjects indicates that thrombogenesis is a frequent systemic reaction to injury; whilst post-traumatic activation of the coagulation mechanism and a consumptive coagulopathy involving circulating platelets and clotting factors seem underlying mechanisms. Arterial thrombosis in injured or burned subjects may be regarded as a breakdown of the unsteady, post-traumatic equilibrium between thrombogenesis and thrombolysis. Under these circumstances, atherosclerosis could act as a predisposing and localizing factor, whilst thrombosis in coronary arteries would be the most important manifestation.