An analysis of deep vein thrombosis in burn patients (part II): A randomized and controlled study of thrombo-prophylaxis with low molecular weight heparin

Ahuja, Rajeev; Bansal, Priya; Pradhan, Gaurav; Subberwal, Manju

doi:10.1016/j.burns.2016.08.007

Cited by 15 publications

(8 citation statements)

References 32 publications

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“…In contrast, Ahuja et al ( 113 ) published a randomized, controlled trial in 2016 of 100 patients with 30% to 60% TBSA burns that examined DVT risk factors and the use of chemoprophylaxis. In the control group of 50 patients that did not receive chemoprophylaxis, four patients (8%) had sonographic evidence of DVT, compared with none of the patients on chemoprophylaxis.…”

Section: Clinical Complications Of Burn-induced Coagulopathymentioning

confidence: 99%

Burn-Induced Coagulopathies: a Comprehensive Review

Ball

Keyloun

Brummel‐Ziedins

et al. 2019

Shock

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Burn-induced coagulopathy is not well understood, and consensus on diagnosis, prevention, and treatments are lacking. In this review, literature on burn-induced (and associated) coagulopathy is presented along with the current understanding of the effects of burn injury on the interactions among coagulation, fibrinolysis, and inflammation in the acute resuscitative phase and reconstructive phase of care. The role of conventional tests of coagulopathy and functional assays like thromboelastography or thromboelastometry will also be discussed. Finally, reported methods for the prevention and treatment of complications related to burn-induced coagulopathy will be reviewed.

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Section: Clinical Complications Of Burn-induced Coagulopathymentioning

confidence: 99%

Burn-Induced Coagulopathies: a Comprehensive Review

Ball

Keyloun

Brummel‐Ziedins

et al. 2019

Shock

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“…After review of collected data but before analyses, we decided to exclude 10 randomised controlled trials from the main analysis, judging that differences in some of the predefined effect modifiers (baseline disease status, median participant age, and mean treatment duration) would threaten transitivity of the network. 35 53 54 55 56 57 58 59 60 61 62 Nevertheless, we noted evidence of inconsistency in the node-splitting models of the venous thromboembolism and bleeding outcome. We found that six additional trials on interventions that are generally not used anymore in daily practice (platelet inhibitors, heparinoids, and coumarins) increased statistical inconsistency without contributing significant information to the network.…”

Section: Resultsmentioning

confidence: 75%

Anticoagulants for thrombosis prophylaxis in acutely ill patients admitted to hospital: systematic review and network meta-analysis

Eck

Elling

Sutton

et al. 2022

BMJ

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Objective To assess the benefits and harms of different types and doses of anticoagulant drugs for the prevention of venous thromboembolism in patients who are acutely ill and admitted to hospital. Design Systematic review and network meta-analysis. Data sources Cochrane CENTRAL, PubMed/Medline, Embase, Web of Science, clinical trial registries, and national health authority databases. The search was last updated on 16 November 2021. Eligibility criteria for selecting studies Published and unpublished randomised controlled trials that evaluated low or intermediate dose low-molecular-weight heparin, low or intermediate dose unfractionated heparin, direct oral anticoagulants, pentasaccharides, placebo, or no intervention for the prevention of venous thromboembolism in acutely ill adult patients in hospital. Main outcome measures Random effects, bayesian network meta-analyses used four co-primary outcomes: all cause mortality, symptomatic venous thromboembolism, major bleeding, and serious adverse events at or closest timing to 90 days. Risk of bias was also assessed using the Cochrane risk-of-bias 2.0 tool. The quality of evidence was graded using the Confidence in Network Meta-Analysis framework. Results 44 randomised controlled trials that randomly assigned 90 095 participants were included in the main analysis. Evidence of low to moderate quality suggested none of the interventions reduced all cause mortality compared with placebo. Pentasaccharides (odds ratio 0.32, 95% credible interval 0.08 to 1.07), intermediate dose low-molecular-weight heparin (0.66, 0.46 to 0.93), direct oral anticoagulants (0.68, 0.33 to 1.34), and intermediate dose unfractionated heparin (0.71, 0.43 to 1.19) were most likely to reduce symptomatic venous thromboembolism (very low to low quality evidence). Intermediate dose unfractionated heparin (2.63, 1.00 to 6.21) and direct oral anticoagulants (2.31, 0.82 to 6.47) were most likely to increase major bleeding (low to moderate quality evidence). No conclusive differences were noted between interventions regarding serious adverse events (very low to low quality evidence). When compared with no intervention instead of placebo, all active interventions did more favourably with regard to risk of venous thromboembolism and mortality, and less favourably with regard to risk of major bleeding. The results were robust in prespecified sensitivity and subgroup analyses. Conclusions Low-molecular-weight heparin in an intermediate dose appears to confer the best balance of benefits and harms for prevention of venous thromboembolism. Unfractionated heparin, in particular the intermediate dose, and direct oral anticoagulants had the least favourable profile. A systematic discrepancy was noted in intervention effects that depended on whether placebo or no intervention was the reference treatment. Main limitations of this study include the quality of the evidence, which was generally low to moderate due to imprecision and within-study bias, and statistical inconsistency, which was addressed post hoc. Systematic review registration PROSPERO CRD42020173088.

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“…Potential risk factors for venous thrombosis following burns were identified as follows: wound infections, prolonged hospital stay, obesity, total body surface area affected by burn, prolonged immobility, and D-dimer elevation. [29][30][31] Harrington et al have looked into the risk of pulmonary embolism after burns, wherein advanced age and total body surface area were identified as two potential factors. 32) Organophosphate or carbon monoxide intoxication was categorized in the disaster category as "man-made" event, following, for example, an industrial accident.…”

Section: Main Findings On How Burns and Intoxications Impact Venous Diseasementioning

confidence: 99%

Review on Disasters and Lower Limb Venous Disease

Gianesini

Menegatti

Bottini³

et al. 2021

Annals of Vascular Diseases

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As per the World Health Organization, a disaster is defined as "an event that occurs in most cases suddenly and unexpectedly, causing severe disturbances to people or objects affected by it, resulting in the loss of life and harm to the health of the population." A number of health issues are often reported following disasters, such as physical and psychological trauma, infections, malnutrition, and cardiovascular events. Among these, venous thromboembolism is deemed serious and thus should be taken into consideration. Indeed, its risk has been demonstrated to increase following earthquakes, floods, burns, and intoxications. The recent coronavirus pandemic summarizes some of the main triggering factors involved in acute and chronic venous disease development in a disaster setting: inflammation, infection, lockdown-induced reduced mobility, potential malnutrition, and overweight. Proper venous risk assessment and guideline application have been determined to be essential in disaster management, particularly in the current time in which sheltering could lead to a potential exacerbation of the pandemic, which can only increase the risk for venous thrombotic diseases.Global scientific teamwork is needed to make the recommendations as evidence-based and as homogeneous as possible among continents. In this present review, we focus on how earthquakes impact venous thromboembolism, including an analysis of other disaster-related conditions, such as burns and intoxication. (This is a review article based on the informative seminar of the 40th Annual Meeting of Japanese Society of Phlebology.

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An analysis of deep vein thrombosis in burn patients (part II): A randomized and controlled study of thrombo-prophylaxis with low molecular weight heparin

Cited by 15 publications

References 32 publications

Burn-Induced Coagulopathies: a Comprehensive Review

Burn-Induced Coagulopathies: a Comprehensive Review

Anticoagulants for thrombosis prophylaxis in acutely ill patients admitted to hospital: systematic review and network meta-analysis

Review on Disasters and Lower Limb Venous Disease

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