Venous thromboembolism in burns patients: are we underestimating the risk and under-dosing for prophylaxis

Mr Patrick Lu1,2, Karl-Anton Harms2, Cheng Lo1,2, Heather Cleland1,2

1Department of Surgery, Central Clinical School, Monash University, , Australia, 2Victorian Adult Burns Service, The Alfred, , Australia

Abstract:

Methods:

Prospective data was collected from all adult admissions with >10% total body surface area (TBSA) burns for AFXa levels to identify if recommended levels for adequate prophylaxis was achieved or not.

Preliminary results (at 3 months):

Preliminary results demonstrate that 92.3% of patients (12/13) had less than prophylactic AFXa levels on initial measurement. 75% (9/12) of these sub-prophylactic patients failed to achieve prophylactic levels of AFXa by discharge. Currently, no predictive factors of ability to achieve prophylactic AFXa levels have been identified, however, participant recruitment is ongoing.

Conclusions:

Many burn patients are receiving inadequate doses of prophylaxis to achieve target AFXa levels for prophylaxis. Identifying patient factors which predict sub-prophylactic AFXa levels may provide guidance for future studies trialing various dosing regimens to improve thromboprophylaxis. Updated results and recommendations will be presented at the ANZBA conference.


Biography:

Venous thromboembolism (VTE) is a preventable complication among hospitalised burn patients that is associated with significant morbidity and mortality. There is no current consensus on the best form of prophylaxis. At our institution, subcutaneous low molecular weight heparin in the form of enoxaparin sodium (Clexane©) is used at a daily dose of 40mg. However, due to the unique metabolic changes in the acute phase of burn injury, the pharmacokinetics of Enoxaparin is altered resulting sub-prophylactic anti-factor Xa (AFXa) levels. Although the current evidence base is limited to a single centre, this data creates concern that our current protocolled Enoxaparin dose may be inadequate.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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