Analysis of deep vein thrombosis in burn patients

Pulmonary embolism in burns, is there an evidence based prophylactic recommendation? Case report and review of literature

“…Additionally, prospective studies categorizing the risk factors for VTE in this setting have not been published likely secondary to the low incidence of clinical DVT and PE in burn patients although having a physiologic tendency to develop such events. Using the National Burn Repository database in 2010, Pannucci et al [7] found a 0.61% incidence of VTE in burn patients, while others found an even lower incidence: 0.25% for DVT and 0.05% for PE [8]. This data has led some burn centers to defer the use of chemical prophylaxis in all patients.…”

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

“…The control and study groups were matched and comparable for all demographics, except BMI and %TBSA burns, which surprisingly were significantly higher in the study group ( [9] 30 DUS (R) 23% (7) LMWH or mechanical (6) Fecher et al [7] 4102 DUS (S) 0.25% (10) Routine heparin Bushwitz et al [16] 1111 DUS and venography 0.27% (3) Routine heparin or LMWH diagnosed on Doppler ultrasound (DUS). None of the patients in the study group (50 patients on enoxaparin prophylaxis) developed DVT (zero percent).…”

“…It is well documented in trauma literature that complications from DVT chemoprophylaxis are not common [13][14][15] but much remains unknown regarding the real risks and benefits of thrombo-prophylaxis for the burn population. Fecher et al reported no complications with routine DVT chemoprophylaxis with heparin in a large retrospective study on 4102 patients [7]. Similarly, Bushwitz et al found no incidence of heparin induced thrombocytopenia in their retrospective study of 1111 burn patients, 600 of whom received heparin prophylaxis and the other 511 patients received enoxaparin [16].…”

“…The reported incidence of DVT in burn patients ranges from 0.9% [5] to 53% [6] if no DVT prophylaxis is provided (Table 1, study part-1). This incidence reduces to 0.25% [7] and to 2.4% [8] if prophylactic measures are adopted but it may still be as high as 23% if predisposing co-morbid features are present [9] (Table 1). In a large retrospective study on 33,637 thermally injured patients, Pannucci et al [10] reported an incidence of 0.61% for VTE but they could not comment on the status of DVT prophylaxis as they lacked relevant records.…”

“…These two risk factors were derived by multivariable logistic regression and a weighted risk scoring system [11]. Several other risk factors have been implicated by various studies but these associations have low objective evidence [4,5,7,9,10,17,19,20]. There is still a need in burn patients to address the risk factors for DVT and further evaluate the complications with routine chemoprophylaxis to better document the risk-benefit ratio.…”