Thromboembolic Complications in Burn Patients and Associated Risk Factors

Abstract

Early mobilization and deep venous thrombosis (DVT) prophylaxis have been shown to reduce the incidence of DVT and pulmonary embolism among hospitalized patients, yet thromboembolic complications remain a great concern, especially to those who remain immobilized for an extended period of time. There are many risk factors associated with the development of thromboembolism, especially DVT. The main objective of this retrospective study is to estimate the occurrence of DVT in burn patients and to investigate some burn-related risk factors. A retrospective examination of DVT cases was conducted among the acute burn patients admitted to our Regional Burn Center during 2008. The analysis included the demographic factors, preexisting medical conditions, ventilator support, number of surgeries and blood transfusions, and use of central line. There was a total of 97 diagnosed patients with DVT and among them 86 were adult acute burn patients. There were 113 diagnosed with DVTs in 86 burn patients, including 22 patients diagnosed with DVT at multiple sites either in one screening or in subsequent screenings. Incidence of DVT at the center was 5.92 per 100 adult acute burn admissions. Men had more DVT than women (6.87 vs. 3.34%, relative risk 2.05, P < .05). The average percentage of %TBSA was smaller in the patients who were more than 50 years of age compared with the patients who were 49 years or younger (21.97 vs. 34.77%, P < .05). Among the patients with DVT, 80 (93%) had a central venous catheter before DVT developed and the other six never had a central venous catheter. The most common site for DVT development was common femoral vein site 89%. The average number of procedures before DVT was 7.84 ± 8.36, and blood transfusions were 39.55 ± 108.37 units. Six patients (7%) died in the hospital within these study cohorts and there was no indication that pulmonary embolism was the cause of the deaths. The study showed that the incidence of DVT in the burn center was comparable with the incidences reported in the literature. Being of male sex, a smoker, an alcoholic, high-age group, high %TBSA, use of central line, increased number of surgeries, and increased number of blood transfusions are identified as possible predisposing factors for DVTs. Further meaningful evaluation to determine the incidence of DVT in burn patients and its associated risk factors will require large multicenter, well-controlled, prospective designed study.

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

“…It was noticed that patients who developed DVT had significantly higher %TBSA burns (p=0.011), prolonged period of immobility (p<0.001) and a longer duration of stay (p=0.008) when compared to other patients in the control group (Table 4). Various other studies have identified higher %TBSA burns as a significant risk factor for development of DVT [4,5,7,11,20]. Fecher et al [7] reported that their patients with burn of 34.7 AE25.3 %TBSA were at significant risk to develop DVT compared to our study where significant risk was seen in patients with 50 AE4.08 %TBSA burns.…”

“…In the study by Fecher et al the patients had a mean age of 47AE22.7years [7], with 50% patients sustaining inhalation injury, all patients had undergone excision and skin grafting with prolonged immobilization, and one patient had femoral venous catheter, compared to our younger patients (age 25.5AE7.42years), with no patient having inhalation injury, excision surgery or femoral catheter. [20]. It seems from our study that even if the mean % TBSA burns was higher in the study group none of the patients developed DVT on chemoprophylaxis.…”

“…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.…”

Predisposing factors for candidemia in patients with major burns

“…Thus, it might be possible that candidemia causes the thromboembolic complication and not the other way around. A recent study conducted by Mullins et al investigated thromboembolic complications in burn patients and identify associated predisposing factors such as male gender, nicotine/alcohol abuse, advanced patients age, greater TBSA, use of central lines, increased number of surgical procedures and increased number of blood transfusions as possible risk factors for deep venous thrombosis [23]. To further investigate the increased number of thromboembolic complications among burn patients with candidemia a large multicenter prospective cohort study would be necessary.…”

Feet sunk in molten aluminium: The burn and its prevention

“…An early medical treatment and consultation of a plastic surgeon are warranted and should be guaranteed. As occurs in other burn patients, thromboembolic prophylaxis should be initiated to prevent thromboembolic complications resulting in immobilization and the potential acquired hypercoagulable state sometimes presenting in these patients [8,9].…”