Optimizing Prophylactic Anticoagulation in Burns is Associated with Low Incidence of Venous Thromboembolic Complications

Abstract

Venous thromboembolism (VTE) complications in burn patients are often under-diagnosed and potentially serious. Thromboprophylaxis in this population remains controversial. Objective: Assess the impact of optimizing prophylactic anticoagulation with enoxaparin in burn patients on the incidence of venous thromboembolism (VTE). Methods: Case-control study conducted in intensive burn care department in Tunisia during 24 months, (February 2018- February 2020). Patients were divided into 2 groups according to the prophylactic anticoagulation modalities: - G1 (Equation) receiving enoxaparine en mg/12H = 22.8 + (3.3 × % TBSA/10) + (1.89 × (weight in kg)/10)) - G2 (No équation) receiving enoxaparine at a dose of 0.5mg/kg, twice daily The goal of prophylactic antifactor Xa level was 0.2- 0.4 IU/ml Results: During study period, 216 patients were included divided into 2 groups: G1 (n= 108) et G2 (n= 108). The groups were comparable in terms of sex, age, weight, burned skin surface and VTE risk. Also, severity of the 2 groups was comparable regarding: smoke inhalation (p=0.46), use of mechanical ventilation (p=0.22), use of catecholamines within 48 hours (p=0.56) and rescue incision (p=0.77). In the equation group, initial dose of enoxaparin was 0.42± 0.12 mg. Target anti Xa was reached at the 1st dosage in 55 patients 55 (50.9%). The median final dose of enoxaparin required to reach the anti Xa target was 52 mg every 12 hours (range, 35-69 mg). No episodes of bleeding, thrombocytopenia, or heparin allergy were documented in either group. The incidence of VTE complications was higher in group 2 than in group 1 (8.3% versus 3.7%; p=0.001 with an OR=1.6 and CI [0.47-1.03]). The length of stay was longer for G2 with a significant difference (30 days vs 22 days; p=0.001). Mortality was the same for two groups. Conclusion: Optimizing thromboprophylaxis in severely burned patients with enoxaparin, using the enoxaparin dosing eqauation allows to achieve prophylactic anti-Xa level and to reduce risk of VTE complications.