Abstract
The aim of this study was to describe the timing of venous thromboembolism diagnosis in patients with severe burns and determine the relationship between venous thromboembolism prophylaxis and venous thromboembolism development in a large trauma hospital. A retrospective cohort study over 10 years from 2009 to 2019 was conducted. Records of 226 patients with >20% total body surface area burns were surveyed, and 20 patients with symptoms suggestive of venous thromboembolism had a diagnosis of VTE confirmed on imaging. Enoxaparin was the most common primary thromboprophylaxis (85%, n = 192), followed by heparin (13.71%, n = 31) and sequential compression devices (0.88%, n = 2). Compared with patients who did not develop a venous thromboembolism, patients who developed a venous thromboembolism had a mean difference in time from admission to thromboprophylaxis prescription of 1.72 days (95% CI = −1.50 to 4.92, p > 0.05) and 10.51 days in those who developed a pulmonary embolus (mean difference = 10.51, 95% CI = 3.73 to 17.32, p = 0.0006). A threshold of 4 days was identified by which 96% of patients who never developed venous thromboembolism during admission were prescribed prophylaxis, compared with 32% of those who developed a pulmonary embolus. No bleeding or adverse events were recorded. Timely prescription of thromboprophylaxis in patients with severe burns is critical in reducing venous thromboembolism incidence. Avoidance of delay post injury is especially critical in preventing venous thromboembolism development. Guidelines on thromboprophylaxis must be considered on an individualised patient basis, considering likely surgical requirements and obesity.
Highlights
Studies determining venous thromboembolism (VTE) incidence in people with severe burns estimate an incidence between 6% and 10%, with pulmonary embolism (PE) accounting for 0.61–3.2% incidence [1,2,3]
From a pathophysiological perspective, increased risk of VTE events in burn patients is explained by a number of factors: dehydration secondary to loss of the protective epithelial layer [7], and hypercoagulability of blood arising through activation of a global inflammatory response [7]
This study included 226 adults, of whom 20 (8.85%) developed either a deep vein thrombosis (DVT), PE, or cerebrovascular event directly associated with patent foramen ovale (Figure 1)
Summary
Studies determining venous thromboembolism (VTE) incidence in people with severe burns estimate an incidence between 6% and 10%, with pulmonary embolism (PE) accounting for 0.61–3.2% incidence [1,2,3]. VTE events have significant correlation with poorer patient outcomes, including longer hospital stay, morbidity, and mortality [4,5,6]. There is evidence that the hyperdynamic nature of circulation post-burn increases renal clearance, resulting in faster elimination of anticoagulants, and suggestions have been made to increase doses if clinically appropriate [8]. Most hospital systems and expert groups include VTE prophylaxis in their admission guidelines to reduce hospitalacquired VTE [10,11]; these guidelines may be inappropriately applied, or clinical course may contraindicate its use. This study was undertaken to determine the correlation between timing of first dose VTE prophylaxis upon admission and timing of VTE events, as well as to assess sub-optimal prophylaxis dosing in at-risk patients on a caseby-case basis to analyse areas of improvement. Data in this study included inpatient notes from Melbourne’s Alfred Hospital, which provides the state-wide service for adult burns, and corresponding records from the Burns Registry of Australia and New Zealand (BRANZ) database
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
