gms | German Medical Science

Background: In literature, prophylaxis for deep vein thrombosis and pulmonary embolism in the burn population is still controversially discussed. At our burn center, all patients suffering ≥50% total body surface area (TBSA) burn are not receiving heparin as thromboembolic prophylaxis. This study analyzes our regime and the risk of Heparin-induced-thrombocytopenia in the burn population.

Methods: The incidence of thromboembolic complications, respectively deep vein thrombosis, pulmonary embolism, arterial thrombosis, Heparin-induced-thrombocytopenia (HIT) and Disseminated Intravasal Coagulation (DIC) in 622 patients treated in our Burn Center between 2004 and 2012 was analyzed retrospectively. Exclusion criteria were traumatic brain injury, comfort therapy due to poor prognosis and primary care abroad.

Results: In group I (burn ≥50% TBSA: n=79; mean age 49; no prophylaxis) eight patients suffered from a thrombembolic event (incidence 17.8%). None of the patients in this group developed HIT. In group II (burn <50% TBSA: n=543; mean age 49; prophylaxis with UFH or LMWH) 15 patients suffered from a thrombembolic complication (incidence of 2.8%) and seven developed HIT (incidence 2.1%). The incidence for DIC was significant higher in the population with burn <50% TBSA receiving no prophylaxis (incidence 14.7%; p<0.001).

Conclusion: According to our retrospective data patients with burns 50% TBSA do not benefit from a thromboembolic prophylaxis with heparin. In patients with TBSA burn <50% prophylaxis should still be recommended. The incidence of DIC without prophylaxis was higher in both groups. Nevertheless prospective data need to be acquired.