Dr Dane Holden^1,2, Yvonne Singer¹, Hadley  Bortz¹, Sharon Selvanayakam¹

¹The Alfred, Melbourne, Australia, ²Monash University , Clayton, Australia

Abstract:

Severe Burn patients are in the high-risk category for VTE due to the presence of profound systemic hyperocagulable state, prolonged bed rest, performance of repeated surgical procedures, femoral venous catheter insertion and recurrent bouts of sepsis(1).  Between 2013 and 2018, there were 20 patients (3.9%) with burns >10% TBSA burns who developed a VTE at the Victorian Adult Burn Service (VABS) at The Alfred, with prevalence increasing in line with increasing TBSA2. Incidence is most common in those with major burns (>20%), full thickness burns, advanced age, concurrent inhalational injury, increased weight (>100kg, BMI >30), ICU stay and mechanical ventilation(2).

International literature describes standard prophylactic dosing (40 mg enoxaparin daily(2), 30mg enoxaparin twice-daily(1) or 40mg twice daily(3)) as being inadequate in the majority of severe burns patients(2,3).  Instead, increased dosing above standard, as well as weight-based dosing regimens have been recommended(2,3,4).

To decrease this unacceptably high rate of VTE events in our burns population the VABS has implemented a new VTE prophylaxis guideline utilising weight based dosing and anti-factor Xa level based adjustments.

1.Guyatt G, Akl E, Crowther M, Gutterman D, Schuunemann J. Antithrombotic therapy and prevention of thrombosis, 9th edition: American college of chest physicians evidence-based clinical guidelines. Chest 2012;141:7S-47S

2.Lu P, Harms KA, Paul E, Bortz H, Lo C, Cleland H. Venous thromboembolism in burns patients: Are we underestimating the risk and underdosing our prophylaxis? J Plast Reconstr Aesthet Surg. 2020 Dec 13:S1748-6815(20)30678-1.

3.McKinzie B., Nizamani R., Jones S., King B., Williams F,. Single-centre Experience with Venous thromboembolism prophylaxis for obese burn patients. Journal of burn care and research. Volume 42:(3);365-368

4.Cronin B., Godat L., Berndtson A., et al. Anti-Xa guided enoxaparin dose adjustment improves pharmacologic deep venous thrombosis prophylaxis in burn patients. Burns 45(2019):818-824

Biography:

Full time Burns Surgeon at the Alfred hospital with a background in General Surgery.