Venous thromboembolism in burn patients – low incidence or underdiagnosis?

Abstract

Venous thromboembolism (VTE), essentially deep venous thrombosis and pulmonary embolism, urinary tract infection, and renal failure are the main unplanned hospital events with negative long-term impact on burn patients’ rehabilitation. Due to the hypercoagulable state induced by severe critical burns, either in the acute or recovery phase and the intimal vascular damage, the risk of VTE is increased, with an incidence varying from 0.4% to almost 60%. Other risk factors for VTE in burn patients are prolonged immobilization, long and multiple surgical interventions, central venous catheterization, wound infection and sepsis, extensive burns, and red blood cell transfusion. To avoid underdiagnosing VTE, in face of increased incidence of asymptomatic venous thromboembolism, high risk-patients should be routinely screened using Doppler ultrasound. Patients’ weight and burn size, as well as the high incidence of heparin resistance in the first weeks after injury, should be considered when establishing the optimal dose for venous thromboembolism prophylaxis, targeting an anti-Xa level of 0.2-0.5 IU/mL.

Keywords

• deep venous thromboembolism
• venous thromboembolism
• burns
• altered pharmacokinetics
• hypercoagulability