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

Article Sidebar

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

Downloads

Download data is not yet available.

Submit your own article

Register as an author to reserve your spot in the next issue of the Medical Research Archives.

Author Registration

Join the Society

The European Society of Medicine is more than a professional association. We are a community. Our members work in countries across the globe, yet are united by a common goal: to promote health and health equity, around the world.

Join Europe’s leading medical society and discover the many advantages of membership, including free article publication.

Membership

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: 22 dec. 2024. doi: https://doi.org/10.18103/mra.v11i6.3960.
ABNT APA BibTeX CBE EndNote - EndNote format (Macintosh & Windows) MLA ProCite - RIS format (Macintosh & Windows) RefWorks Reference Manager - RIS format (Windows only) Turabian
Issue
Vol 11 No 6 (2023): June Issue, Vol.11, Issue 6
Section
Research Articles

The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.

 

References

1. Siah S, El Farouki A. Prévention de la maladie thromboembolique veineuse chez le brûlé. Ann Burns Fire Disasters. Juin 2014;27(2):76-81.
2. Rue LW, Cioffi WG, Rush R, McManus WF, Pruitt BA. Thromboembolic complications in thermally injured patients. World J Surg. 1992 Nov;16(6):1151-4.
3. Mayou BJ, Wee J, Girling M. Deep vein thrombosis in burns. Burns. 1981 Oct;7(6): 438‑40.
4. Cronin BJ, Godat LN, Berndtson AE, Pham A, Kolan S, Box K, et al. Anti-Xa guided enoxaparin dose adjustment improves pharmacologic deep venous thrombosis prophylaxis in burn patients. Burns. 2019 Jun;45(4):818-24.
5. Malinoski D, Jafari F, Ewing T, Ardary C, Conniff H, Baje M, et al. Standard prophylactic enoxaparin dosing leads to inadequate anti-Xa levels and increased deep venous thrombosis rates in critically ill trauma and surgical patients. J Trauma. 2010 Apr;68(4):874-80.
6. Faraklas I, Ghanem M, Brown A, Cochran A. Evaluation of an enoxaparin dosing calculator using burn size and weight.J Burn Care Res. 2013 Nov;34(6):621-7.
7. Wahl WL, Brandt MM. Potential risk factors for deep venous thrombosis in burn patients. J Burn Care Rehabil. 2001 Mar;22(2):128-31.
8. Wahl WL, Brandt MM, Ahrns KS, Zajkowski PJ, Proctor MC, Wakefield TW, et al. Venous thrombosis incidence in burn patients: preliminary results of a prospective study. J Burn Care Rehabil. 2002 Mar;23 (2):97-102.
9. Fecher AM, O’Mara MS, Goldfarb IW, Slater H, Garvin R, Birdas TJ, et al. Analysis of deep vein thrombosis in burn patients. Burns. 2004 Sep;30(6):591-3.
10. Bushwitz J, Leclaire A, He J, Mozingo D. Clinically significant venous thromboembolic complications in burn patients receiving unfractionated heparin or enoxaparin as prophylaxis. J Burn Care Res. 2011 Nov;32(6):578-82.
11. Ganau M, Ligarotti GI, Meloni M, Chibbaro S. Efficacy and safety profiles of mechanical and pharmacological thromboprophy -laxis. Ann Transl Med. 2019 Sep;7 Suppl 6:224.
12. Bertin Maghit M, Bargues L, Jaber S, Braye F, Marduel YN. Prévention de la maladie thromboembolique veineuse chez le brûlé. Ann Fr Anesth Reanim. Août2005;24(8):947-50.
13. Pannucci CJ, Osborne NH, Wahl WL. Venous thromboembolism in thermally injured patients: analysis of the national burn repository.J Burn Care Res. 2011 Jan;32(1):6-12.
14. Liu A, Minasian RA, Maniago E, Justin Gillenwater T, Garner WL, Yenikomshian HA. Venous thromboembolism chemoprophylaxis in burn patients: a literature review and single-institution experience. J Burn Care Res. 2021 Feb;42(1):18-22.
15. Lin H, Faraklas I, Saffle J, Cochran A. Enoxaparin dose adjustment is associated with low incidence of venous thromboembo-lic events in acute burn patients. J Trauma. 2011 Dec;71(6):1557-61.
16. Lin H, Faraklas I, Cochran A, Saffle J. Enoxaparin and antifactor Xa levels in acute burn patients. J Burn Care Res. 2011 Jan;32(1):1-5.
17. Costantini TW, Min E, Box K, Tran V, Winfield RD, Fortlage D, et al. Dose adjusting enoxaparin is necessary to achieve adequate venous thromboembolism prophylaxis in trauma patients. J Trauma Acute Care Surg. 2013 Jan;74(1):128-33.
18. McKinzie BP, Nizamani R, Jones S, King B, Williams FN. Single-center experience with venous thromboembolism prophylaxis for obese burn patients. J Burn Care Res. 2021 May;42(3):365-8.
19. Hirsch DR, Ingenito EP, Goldhaber SZ. Prevalence of deep venous thrombosis among patients in medical intensive care. J Am Med Assoc. 1995 Jul;274(4):335-7.
20. Rostas JW, Brevard SB, Ahmed N, Allen J, Thacker D, Replogle WH, et al. Standard dosing of enoxaparin for venous thromboembolism prophylaxis is not sufficient for most patients within a trauma intensive care unit. Am Surg. 2015 Sep;81(9):889-92.
21. Priglinger U, Delle Karth G, Geppert A, Joukhadar C, Berger R, Hülsmann M, et al. Prophylactic anticoagulation with low dose enoxaparin: is the subcutaneous route appropriate in the critically ill? Crit Care Med. 2003 May;31(5):1405-9.
22. Jiménez D, Díaz G, Iglesias A, César J, García Avello A, Martí D, et al. Anti-factor Xa activity of enoxaparin for thromboprophylaxis in nonsurgical patients is dependent on body mass. Arch Bronconeumol. 2008 Dec;44(12):660-3.
23. Harrington DT, Mozingo DW, Cancio L, Bird P, Jordan B, Goodwin CW. Thermally injured patients are at significant risk for thromboembolic complications. J Trauma 2001;50:495.