21 Thromboembolic Complications

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The frequency ofthromboembollc complications In burn patients has been bilization and frequent operative procedures necessary to estimated to range from 0.4% to 7%. The clinical sigilficance of these achieve wound closure, and the potential for vascular damage events is often debated and has prompted some centers to adopt the routine prophylactic use of low dose heparin prophylads. A 10 y secondary to multiple venous line insertions. review of 2,103 burn patients treated at this institution was undertaken. The clinical significance of this complication is often debated. Twenty-five (1.2%) patients, with a mean age of 40.0 years and an Some burn centers routinely administer low dose heparin average burn size of 49.3% total body surface area (TBSA), wer prophylaxis to all thermally injured patients. Other centers identified as having significant pulmonary thromboembollsm (PTE). In only 3 (0.14%) patients was the thromboembollsm considered to be a reserve prophylactic heparin therapy for use in those patients cause of death. Nineteen (0.9%) patients, with an average age of 36.7 with additional major risk factors for thromboembolism. These years and a mean burn she of 43.3% TBSA, developed dlinically evident include advanced age, previous history of venous thrombosis, deep venous thrombosis (DVT); however, in only 1 (0.05%) patient did obesity, lower extremity trauma, and malignancy. These investhe disease progress to fatal PTE. A review of the literature reveals a 0.6%to$%ide ofol tigators contend that the risk associated with prophylactic dons related to low dose beparin therapy which includes bleeding, heparin therapy exceeds the risk of the disease process itself. thrombocytopenla, and arterial thrombosis. We fed that the infrequency The purpose of this study is to determine the incidence and oficlinically signifcant PTE and DVT in burn patients and the comparable clinical significance of thromboembolic complications in a popor greater rate of complications associated with heparin prophylaxis ulation of thermally injured patients. mitigate against the routine use of low dose heparin therapy except In patients at hg risk for these events. Methods and Materials The charts of all thermally injured patients admitted to the U.S. Estimates of the frequency of thromboembolic complications Army Institute of Surgical Research during the period from following thermal injury range from 0.4% to 7%. Mechanical January 1, 1980 to December 31, 1989 were reviewed for and pharmacologic methods of prophylaxis have been em- evidence of thromboembolic complications. The patient age, ployed in attempts to reduce the incidence of this complication, burn size, and the presence of established risk factors were Mechanical measures have included early mobilization, elastic recorded. The incidence of deep venous thrombosis (DVT) and wrapping, or application of pneumatic compression devices to pulmonary thromboembolism (PTE) was segregated by age and the lower extremities. In addition, elevation of the foot of the burn size by use of a multiway table. Log linear analysis was bed and avoidance of inadvertent pressure on the lower extrem- performed to identify associations between incidence, age, and ity during surgery and in the postoperative period have been burn size. The signs and symptoms of thromboembolism as well suggested. Recommended preventive pharmacologic measures as the method of documentation were recorded. Pulmonary have included low dose heparin, warfarin, aspirin, and various embolism was diagnosed by either ventilation/perfusion scan or dextran solutions [1].