Effects of Disruption in Venous Thromboembolism Prophylaxis in Burn Patients: A Case-Control Study

Introduction: Hospitalized burn-injured patients are at risk for venous thromboembolism (VTE) due to a variety of reasons, including critical illness, immobility, and operative needs. Patients with burn injuries are known to experience altered metabolism post-injury which may impact clearance of chemoprophylaxis. There are currently no standardized dosing recommendations for burn-injured patients and often data is extrapolated from other populations and smaller retrospective studies. The purpose of this study is to explore the differences in risk factors for VTE between burn patients who develop VTE compared to those that do not.


Methods: This retrospective single-center case-control study analyzed burn-injured patients that experienced a new VTE event between 7/2015 - 8/2024. Patients were included if they were over 18 years old, had total body surface area (TBSA) burned greater than 10%, and were hospitalized for more than 1 day. Patients were excluded if they had a history of heparin induced thrombocytopenia (HIT), VTE present at admission, or were on therapeutic anticoagulation. Patients were matched in 1:4 ratio based on year of admission, %TBSA, age and weight. The primary endpoint was the percentage (%) of VTE chemoprophylaxis doses received between cohorts over a maximum of 45 days of hospitalization. Secondary endpoints included hospital length of stay, agent and dose of chemoprophylaxis. Descriptive statistics and multivariate regression were used for analysis.


Results: A total of 111 patients met inclusion criteria and were included for analysis: 23 in the VTE group and 88 in the control group. The average %TBSA was 37.29% in the vte group vs. 25.73% in controls. VTE occurred around day 23 of hospitalization. All VTE patients received chemoprophylaxis (86.3% enoxaparin, 13.7% heparin). In the control group, 89.7% received enoxaparin and the rest did not receive prophylaxis. Patients with VTE had central lines for 20.3 days vs. 16.6 in control. Average doses received in VTE group was 78.3% and 65.5% in control group.


Conclusions: In conclusion, %TBSA and central line duration are likely significant risk factors for VTE in burn patients.