Deep Venous Thrombosis in Burn Patients, the Need for Continuous Surveillance; Lagos State University Teaching Hospital (LASUTH), Ikeja; Our Nigeria Experience
Article Sidebar
-
Venous Thrombo-Embolism, prophylaxis, risk, anticoagulation
Abstract
Background: Venous thromboembolism (VTE) remains a major cause of morbidity and mortality in clinical practice. Burn patients are in the highest risk category for VTE due to pathophysiological changes and use of multiple monitoring system1. Deep venous thrombosis (DVT) prophylaxis in burns has always been contentious. Reported incidence of DVT in burns ranges from 0.25% to 23%2. The objective of our study is to present our experience of VTE in burns in Lagos, Nigeria.
Method: Retrospective study of Burns Patients diagnosed with VTE between May 2016 and April 2021 was conducted in Lagos State University Teaching Hospital. Data were obtained from the case notes and analyzed for demographic characteristics, severity of injury and outcome.
Results: A total of 592 burns injured patients were admitted during the study period. Five patients; four adults and one child were diagnosed with DVT (0.8%) of lower extremities. They were two males and three females with Male to Female ratio 1:1.5. The ages ranged between 8 and 77years, mean 33±23.2 years. TBSA ranged between 22% to 45%, mostly mixed thickness. The average time of diagnosis was 6 weeks post burn. Most common presentation were limb swelling and pain. Confirmation was with Doppler Venous Ultrasound. Treatments included Inferior vena cava filter placement, thrombolysis, and anticoagulation. Mortality was 40% from pulmonary embolism; one of which had a filter.
Conclusion: Burn Injury is one of the main risk factors for DVT, when the Total Body Surface Area (TBSA) ≥40%. Other significant factors are length of hospital stay and the use of central lines. This implies that research for DVT and prophylactic anticoagulation may be considered for burn patients with these risk factors, even if the burn patient is asymptomatic.
Not necessary in the abstract
Same as 1
Confirmation of what?
What research? This is too vague and ambiguous. Was it a conclusion from your study? I don’t think so
Full text article
References
Kesieme, E.; Kesieme, C.; Jebbin, N., Irekpita, E.; Dongo,A. Deep vein thrombosis: A clinical review. J. Blood Med.2011; 2, 59.
Wahl WL, Brandt MM, Ahrns KS, Zajkowski PJ, Proctor MC, Wakefield TW, et al. Venous thrombosis incidence in burn patients: Preliminary results of a prospective study Burn Care Rehabil.2002;23:97-102
Harrington DT, Mozingo DW, Cancio L, Bird P, Jordan B, Goodwin CW. Thermally injured patients are at significant risk for Thromboembolic Complications. J. Trauma.2001;50:495-49.
Mullins F,Mian M, Jenkins D,Brandigi C, Shaveer J, Friedman B et al. Thromboembolic complicationin burn patients and associated risk factors J.Burn care Res 2013;34:355-60
Fecher, M.S. O'Mara, I.W. Goldfarb, H. Slater, R. Garvin, T.J. Birdas, et al. Analysis of deep vein thrombosis in burn patients, burns, 30 (2004), pp. 591-593,
W. Zhang, J.F. Zhang, M. Wang, C.D. Xia, L.J. Wang, B.H. Liu, et al. Occurrence of deep venous thrombosis in adult burn patients and its risk factors, Zhonghua Shao Shang Za Zhi, 36 (2020), pp. 54-57.
Cato, B. Bailiff, J. Price, C. Ermogeneous, J. Hazeldine, W. Lester, et al., Heparin resistance in severe thermal injury: a prospective cohort study, Burns Trauma, 9 (2021), Article tkab032
Tapson VF. Acute pulmonary embolism. N Engl J Med. 2008 Mar 6. 358(10):1037-52.
Haeger K. Problems of acute deep venous thrombosis. I. The interpretation of signs and symptoms. Angiology. 1969 Apr. 20(4):219-23.
McLachlin J, Richards T, Paterson JC. An evaluation of clinical signs in the diagnosis of venous thrombosis. Arch Surg. 1962 Nov. 85:738-44.
Meignan M, Rosso J, Gauthier H, et al. Systematic lung scans reveal a high frequency of silent pulmonary embolism in patients with proximal deep venous thrombosis. Arch Intern Med. 2000 Jan 24. 160(2):159-64.
Snow V, Qaseem A, Barry P, et al. Management of venous thromboembolism: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2007 Feb 6. 146(3):204-10.
Buller HR, Ten Cate-Hoek AJ, Hoes AW, et al. Safely ruling out deep venous thrombosis in primary care. Ann Intern Med. 2009 Feb 17. 150(4):229-35.
Bauersachs R, Berkowitz SD, Brenner B, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010 Dec 23. 363(26):2499-510.
Buller HR, Prins MH, Lensin AW, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012 Apr 5. 366(14):1287-97.