Enoxaparin and Antifactor Xa Levels in Acute Burn Patients

Lin, Hsin; Faraklas, Iris; Cochran, Amalia; Saffle, Jeffrey R.

doi:10.1097/bcr.0b013e318204b346

Cited by 69 publications

(46 citation statements)

References 18 publications

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“…The presence of hypercoagulability after burn is well established, and both the rate of VTE (11) and the need for increased chemo-prophylactic dosing (33, 34) are correlated with increased burn size. Further, post-mortem human studies show microvascular thrombosis in multiple organs, specifically lung and renal tissues, leading to multiple organ dysfunction syndrome (MODS) and death (35, 36).…”

Section: Discussionmentioning

confidence: 99%

Impact of Platelets and Platelet-Derived Microparticles on Hypercoagulability Following Burn Injury

Kuethe

Rice

Veile

et al. 2016

Shock

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An acute burn induced coagulopathy develops after scald injury, which evolves into a subacute, hypercoagulable state. Microparticles, specifically platelet-derived MPs (PMPs), have been suggested as possible contributors. We first developed a model of burn-induced coagulopathy and then sought to investigate the role of platelets and PMPs in coagulation after burn. We hypothesized that changes in circulating platelet and PMP populations after injury would contribute to the post-burn, hypercoagulable state. A murine scald model with 28% TBSA full thickness burn injury was utilized and blood samples were collected at intervals after injury. Circulating MP populations, platelet counts, overall coagulation, and platelet function were determined. Burn injury led to hypercoagulability on post-burn day one (PBD1), which persisted 6 days after injury (PBD6). On PBD1, there was a significant decrease in platelet numbers and a decline in platelet contribution to clot formation with a concomitant increase in circulating procoagulant PMPs. On PBD6, there was a significant increase in platelet numbers and in platelet activation with no change in PMPs compared with sham. Further, on PBD1 decreased ADP-induced platelet activation was observed with a contrasting increase in ADP-induced platelet activation on PBD6. We therefore concluded that there was a temporal change in the mechanisms leading to a hypercoagulable state after scald injury, that PMPs are responsible for changes seen on PBD1, and finally that ADP-induced platelet activation was key to the augmented clotting mechanisms 6 days after burn.

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Section: Discussionmentioning

confidence: 99%

Impact of Platelets and Platelet-Derived Microparticles on Hypercoagulability Following Burn Injury

Kuethe

Rice

Veile

et al. 2016

Shock

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“…Of note, standard prophylactic dosing of enoxaparin, a low-molecular weight heparin, has been shown to be inadequate in patients with large TBSA. Appropriate enoxaparin prophylaxis dose has been shown to correlate linearly with TBSA 31 . Thus, a proposed RCT should consider using antifactor Xa levels to guide prophylactic enoxaparin dosing.…”

Section: Future Directionsmentioning

confidence: 99%

Creation and Validation of a Simple Venous Thromboembolism Risk Scoring Tool for Thermally Injured Patients

Pannucci

Osborne²,

Wahl

2012

Journal of Burn Care & Research

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Objective Venous thromboembolism (VTE) has been identified as a major patient safety issue. We report our use of the National Burn Repository (NBR) to create and validate a weighted risk scoring system for VTE. Methods Adult patients with thermal injury from the NBR admitted between 1995 and 2009 were included. Independent variables were either known or could be derived at the time of admission, including total body surface area burned (TBSA), inhalation injury, gender, and age. The dependent variable was VTE, a composite variable of patients with deep venous thrombosis and/or pulmonary embolus. The dataset was split into working and validation sets using a random number generator. Multivariable logistic regression identified independent predictors. β –coefficients for independent predictors were used to generate a weighted risk score. Results The NBR contained 22,618 patients who met inclusion criteria. The working and validation sets were not statistically different for demographics or risk factors. In the working set, presence of inhalation injury and increased TBSA were independent predictors of VTE. Adjusted β –coefficients were used to generate a weighted risk score which showed excellent discrimination for VTE in both the working (c-statistic 0.774) and validation (c-statistic 0.750) sets. As risk score increased, a linear increase in observed VTE rate was demonstrated in both working and validation sets. Conclusions We have created and validated a simple risk score model to predict VTE risk in thermally injured patients using the NBR. The model is based on risk factors easily identified during initial patient contact.

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“…However, a recent study by Lin et al has shown that 79% of burn patients treated with standard doses of LMWH did not achieve the goal antifactor Xa levels, requiring higher LMWH doses that were correlated with the TBSA. 35 These data indicate that standard dosing of LMWH for VTE prophylaxis is inadequate for patients with acute burns. Furthermore, these patients may require a higher initial dose of LMWH in combination with routine monitoring of antifactor Xa levels.…”

Section: Discussionmentioning

confidence: 97%

Evaluation of Prophylactic Anticoagulation, Deep Venous Thrombosis, and Heparin-Induced Thrombocytopenia in 21 Burn Centers in Germany, Austria, and Switzerland

Busche

Herold²,

Kramer³

et al. 2011

Annals of Plastic Surgery

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Heparin-induced thrombocytopenia (HIT) is a life-threatening complication in intensive care settings. The timely diagnosis and management of HIT are challenging, and the incidences of HIT and deep venous thrombosis (DVT) may be related to prophylactic anticoagulation standards in burn units. We therefore evaluated, using a questionnaire, prophylactic anticoagulation, HIT management, and incidences of DVT and HIT in burn centers located in the German-speaking part of Europe. In the 21 responding burn centers, 1611 patients were treated and the overall incidences for clinically overt DVT and HIT in 2008 were 1.1% and 1.4%, respectively. Burn centers using low molecular weight heparin (LMWH) subcutaneous for all patients had a low rate of DVT (0.9%) and significantly lower rates of HIT (0.2%) relative to all other centers (P < 0.05). The highest rates of HIT (2.7%) and DVT (3.8%) were found in burn centers administering unfractionated heparin intravenous. While current HIT guidelines do not specify the administration of unfractionated heparin or LMWH for burn patients, these data warrant controlled prospective studies to confirm the advantage of LMWH administration in burn patients.

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Enoxaparin and Antifactor Xa Levels in Acute Burn Patients

Cited by 69 publications

References 18 publications

Impact of Platelets and Platelet-Derived Microparticles on Hypercoagulability Following Burn Injury

Impact of Platelets and Platelet-Derived Microparticles on Hypercoagulability Following Burn Injury

Creation and Validation of a Simple Venous Thromboembolism Risk Scoring Tool for Thermally Injured Patients

Evaluation of Prophylactic Anticoagulation, Deep Venous Thrombosis, and Heparin-Induced Thrombocytopenia in 21 Burn Centers in Germany, Austria, and Switzerland

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