Venous thromboembolism in patients with thermal injury

Importance: VTE can be a life-threatening or limb-threatening complication of thermal injury. When controlling for other baseline risk and comorbidities, VTE carries a 3-fold increased risk of death. In at least 20-30% of cases no DVT prophylaxy is used in burn patient.Incidence: The overall incidence for postburn VTE is low (0.61%), including deep venous thrombosis (DVT) (0.48%) and PE (0.18%). However, a large volume of patients has only minor injuries, biasing the results to represent patients with less severe injuries. Published rates of symptomatic pulmonary embolus in burn patients are between .05% and 1.4% among patients with total body surface area (TBSA) burns of greater than 10%, VTE rates double to 1.22%, approximating the incidence of VTE in hospitalized general patients.Risk Factors: Identified risk factors include increased age, increased body mass index increased TBSA burned, infected burn wounds, central venous access, increased mechanical ventilation days, longer ICU stays, and increased number of operative procedures.Risk Assessment: Creation and validation of a simple venous thromboembolism risk scoring tool for thermally injured patients has been done from analysis of the National Burn Repository at 2012.Treatment Guidelines: Despite these risks, there is no consensus regarding the use of VTE prophylaxis. Currently, burn centers are forced to extrapolate data from large, single center case-series of burn patients or other non-burn medical, surgical, and critical care populations when making prophylaxis decisions. Currently, there are no randomized control trials evaluating chemoprophylaxis in burn. LMWH is ideally dosed using real-time dose adjustment and the substantial decreased likelihood of HIT supports LMWH as a first-line agent for VTE prophylaxis in the burn population. When a patient’s clinical situation precludes chemoprophylaxis, intermittent pneumatic compression alone is of substantial benefit. Common thromboprophylaxis practices with subcutaneous enoxaparin in burn centers include doses of 40 mg daily or 30 mg twice daily.Complications: wound hematoma, major bleeding, HIT