Dr Edward Stanley¹, Dr Justine O’Hara¹, Dr Andrea Issler-Fisher¹, Professor Peter Haertsch¹, Professor Peter Maitz¹

¹Concord Repatriation General Hospital, Sydney, Australia

Abstract:

In addition to his clinical work, Edward is completing his PhD at The University of Sydney in reanimating the upper limbs of patients with quadriplegia using nerve transfers.

Introduction

Burns injured patients are high risk for venous thromboembolism (VTE). Standard dosing of enoxaparin for VTE prophylaxis may be inadequate in patients with an acute major burn injury due to a hypermetabolic response. This response leads to augmented drug clearance and increased drug distribution, resulting in unpredictable enoxaparin pharmacokinetics. Clinically, this is reflected by variability in serum anti-factor Xa levels. This variability places burns injured patients at greater risk for VTE. To achieve adequate prophylaxis levels, a calculation based upon weight and percentage total body surface area burns (% TBSA) can be used to safely dose these high-risk patients.

Methods

We report a retrospective cohort study investigating outcomes and safety of dose-adjusted enoxaparin VTE prophylaxis, in patients with burns greater than 20% TBSA and/or greater than 48 hours of anticipated immobility. The primary outcome was the risk of developing a VTE. The secondary outcome, significant bleeding. Participants received twice daily dose-adjusted enoxaparin monitored by serum anti-factor Xa levels.

Results

Participants demonstrated therapeutic serum anti-factor Xa levels to achieve adequate VTE prophylaxis with dose-adjusted enoxaparin.

Conclusion

We found that dose-adjusted enoxaparin is safe and provides a low incidence of VTE in patients with major burns and/or prolonged immobility.

Biography:

Edward is the burns registrar at Concord Repatriation General Hospital.