Burn specific venous thromboembolism prophylaxis: outcomes at fifteen-months.

Guy Sheahan¹, Yvonne Singer¹, Humphrey Walker¹, Sean Xu¹, Heather Cleland¹, Dane Holden¹,
¹Alfred Health, Melbourne, Vic, Australia

Abstract

Background
Patients with severe burns are at high-risk of venous thromboembolism (VTE) due to multiple patient, disease, and treatment factors. Increasing the chemical VTE prophylactic dose may reduce the risk of VTE complications.
Methods
From 1 January 2022, the Alfred implemented a new VTE Prophylaxis guideline for patients with burns >/=20%TBSA. Eligible patients now receive enoxaparin (40mg BD), renally and weight adjusted to obtain a 0.2-0.5 Anti-factor Xa level. Adherence to the VTE guideline, thrombotic or haemorrhagic complications were recorded within the REDCAP® database.
Results
Until May 2023, 44 eligible patients (79% males) were admitted to the ICU, with a median TBSA of 38% (IQR 28-55), and age of 44 years (IQR 31-68). Thirty-one patients received active treatment, with 1 mortality. Six patients had initial contraindications to chemical VTE (2 other trauma, 2 coagulopathic, 2 anticoagulated). Five patients did not initially receive enoxaparin in accordance with the VTE guideline, and 5 patients required dose adjustments. Only one patient developed a thrombotic complication (DVT). However, 12 (39%) patients had bleeding complications, of whom 10 required transfusion, 8 required suture haemostasis, and ultimately, 7 patients required operative evacuation of haematomas underneath newly applied BTM® or under Biobrane®.
Conclusions
The new VTE guideline has been successfully introduced into the Burns Service. Over 17-months only one thrombotic event occurred. However, increased VTE prophylaxis was associated with substantial haemorrhagic complications often resulting in the loss of dermal substitute, and/or other expensive burn products. Further data is required to draw more definitive conclusions and guide change.

Biography

Sean is a fourth year Monash University medical student with a particular interest in burns surgery. He is an honorary researcher with The Alfred, engaged in projects in burns surgery, plastic surgery, general surgery, and interventional radiology. Sean is also a data officer under the Walter and Eliza Hall Institute of Medical Research, contributing to knowledge surrounding clinical outcomes in patients with pancreatic cancer.