An analysis of deep vein thrombosis in burn patients (part II): A randomized and controlled study of thrombo-prophylaxis with low molecular weight heparin.
INTRODUCTION
Morbidity and mortality from venous thrombo-embolism (VTE) remains a significant problem for trauma and medical patients and there are established guidelines for prophylaxis in these patients. However, the efficacy and safety of VTE prophylaxis in thermally injured patients continue to be elusive as it has never been studied in a prospective, randomized fashion. Selective use of VTE prophylaxis, for high risk patients, is practiced by some burn units even if objective evidence is lacking for majority of risk factors enunciated in burn patients. Differing demographics and wound management techniques are other confounding factors mandating more prospective studies to evaluate the need and role of chemoprophylaxis for deep vein thrombosis (DVT) prevention in burn patients. Ours is the first prospective, randomized, controlled study which seeks to identify risk factors for DVT in our patients, and evaluate the role of routine chemoprophylaxis and its complications.


METHODS
The study design (sample size, inclusion/exclusion criteria, randomization, methodology and statistical methods) is detailed in part-1 of this two part manuscript.


RESULTS
Doppler ultrasound (DUS) identified DVT in four out of 50 patients (8% incidence) forming the control group. DVT was not detected in any of the patients on prophylaxis (0% incidence). This difference was found to be statistically significant (p value-0.021). Patients with DVT had significantly higher %TBSA, prolonged immobility and a longer duration of stay as compared to patients without DVT in the control group. Only one patient on enoxaparin prophylaxis developed mild epistaxis which resolved spontaneously. Fifteen patients died during the study out of which two had DVT but none showed autopsy evidence of pulmonary embolism.


CONCLUSION
With a moderate risk of developing DVT (8%) and a complication rate of only 2% with chemoprophylaxis, we feel that routine prophylaxis has the potential to decrease the incidence of VTE, without associated complications, in the moderate to high risk category.
['Ahuja|Rajeev B|RB|', 'Bansal|Priya|P|', 'Pradhan|Gaurav S|GS|', 'Subberwal|Manju|M|']
D000293:Adolescent D000328:Adult D001830:Body Surface Area D002056:Burns D019468:Disease Management D017984:Enoxaparin D004844:Epistaxis D005260:Female D005343:Fibrinolytic Agents D006801:Humans D007902:Length of Stay D008297:Male D008875:Middle Aged D051346:Mobility Limitation D012307:Risk Factors D013997:Time Factors D015599:Trauma Severity Indices D018608:Ultrasonography, Doppler D020246:Venous Thrombosis D055815:Young Adult
Deep vein thrombosis DVT in burns DVT prophylaxis