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

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Published Jun 26, 2023
DOI: https://doi.org/10.18103/mra.v11i6.3960

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Main Article Content

A Mokline
Tunis University El Mananr, Faculty of Medicine of Tunis. Tunisia; Intensive Burn Care Department of Tunis. Burn and Trauma Center. Tunis, Tunisia; UR22SP03
Ghabara R
Tunis University El Mananr, Faculty of Medicine of Tunis. Tunisia; Intensive Burn Care Department of Tunis. Burn and Trauma Center. Tunis, Tunisia
H Fraj
Tunis University El Mananr, Faculty of Medicine of Tunis. Tunisia; Intensive Burn Care Department of Tunis. Burn and Trauma Center. Tunis, Tunisia; UR22SP03
M Ben Saad
Tunis University El Mananr, Faculty of Medicine of Tunis. Tunisia; Intensive Burn Care Department of Tunis. Burn and Trauma Center. Tunis, Tunisia
L Thabet
Intensive Burn Care Department of Tunis. Burn and Trauma Center. Tunis, Tunisia; UR22SP03; Laboratory of Biology
AA Messadi
Tunis University El Mananr, Faculty of Medicine of Tunis. Tunisia; Intensive Burn Care Department of Tunis. Burn and Trauma Center. Tunis, Tunisia; UR22SP03

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.

Article Details

How to Cite
MOKLINE, A et al. Optimizing Prophylactic Anticoagulation in Burns is Associated with Low Incidence of Venous Thromboembolic Complications. Medical Research Archives, [S.l.], v. 11, n. 6, june 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3960>. Date accessed: 15 may 2024. doi: https://doi.org/10.18103/mra.v11i6.3960.
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Issue
Vol 11 No 6 (2023): June Issue, Vol.11, Issue 6
Section
Research Articles

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