Deep venous thrombosis in burn patients: a retrospective analysis Fierens J, Hoste E, Benoit D, Monstrey S, Colpaert K OBJECTIVE: Deep venous thrombosis (DVT) is a well-known cause of major morbidity in the surgical patient population. The objective of this retrospective study is to evaluate the incidence of DVT in our burn centre, identify burn-related risk factors as well as risk factors for bacterial surinfection of DVT. METHODS: All adult burn patients, with a total body surface area (TBSA) more than 10%, diagnosed with DVT and admitted between 2008 and 2016 in our burn centre were retrospectively evaluated. The analysis included demographics, location of central lines, number of surgeries, pre-existing medical conditions and inhalation injury. All patients received either routine weight-adjusted subcutaneous low-molecular weight heparin (LMWH) prophylaxis or intravenous heparin. A continuous heparin infusion with a targeted activated partial thromboplastin time (aPTT) of 1.5 to 2 times the baseline aPTT or enoxaparin 0.5 mg/kg was considered an adequate prophylactic dose of anticoagulant. DVT patients were matched on age, gender and TBSA with our general burn unit population. RESULTS: During the study period 611 patients were admitted to the burn unit. 27 patients were diagnosed with DVT (4.4%). The average length of stay in the DVT group was 56 days, compared to 27 days in the control group (P < 0.01). No increased mortality was found (P= 0.34). Pre-existing medical conditions, inhalation trauma nor blood transfusion were associated with a higher incidence of DVT (P > 0.05). DVT was associated with a sub therapeutic daily dose of LMWH, adjusted for length of stay or time to diagnosis (P < 0.05). A total of 11 (41%) patients had surinfected DVT, with either bacteria (6/11, 54%) or yeasts (5/11; 46%). In all patients a central line was located on the DVT location, with a more frequent femoral site (18/27, 67%). CONCLUSION: This study stresses the importance of routine and correctly dosed LMWH administration in burn patients. It highlights the presence of a central line as a major risk factor and the additional hazard of thrombus surinfection.
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