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

Abstract

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.

Blood utilization in patients with burn injury and association with clinical outcomes (CME)

“…Recent studies of burn patients who received heparin thromboprophylaxis found the incidence of HIT to be 0% to 1.6%. 26,45,46 In comparison, the frequency of HIT in orthopedic and cardiac surgery patients was reported to be 4.9 and 1.0%, respectively. 45,46 While extensive data strongly support the clinical benefit and cost-effectiveness of routine thromboprophylaxis in trauma, surgical, and medical populations, 41 the adverse association between increased number of transfusions and possible overzealous use of therapeutic anticoagulation in our study raises the question about the risk-benefit ratio of routine anticoagulation.…”

“…26,45,46 In comparison, the frequency of HIT in orthopedic and cardiac surgery patients was reported to be 4.9 and 1.0%, respectively. 45,46 While extensive data strongly support the clinical benefit and cost-effectiveness of routine thromboprophylaxis in trauma, surgical, and medical populations, 41 the adverse association between increased number of transfusions and possible overzealous use of therapeutic anticoagulation in our study raises the question about the risk-benefit ratio of routine anticoagulation. Because it was sometimes difficult or impossible to obtain satisfactory diagnostic radiology studies on patients with renal dysfunction who were suspected of having a PE, a number of patients were initiated on therapeutic anticoagulation with heparin on the basis of clinical suspicion alone.…”

“…Burn patients are believed to be at low risk for HIT. Recent studies of burn patients who received heparin thromboprophylaxis found the incidence of HIT to be 0% to 1.6% . In comparison, the frequency of HIT in orthopedic and cardiac surgery patients was reported to be 4.9 and 1.0%, respectively .…”

Free Flap Failure Associated with Heparin-Induced Thrombocytopenia: Is It Preventable?

“…Several reports of failed flap reconstruction attributed to HIT exist in the literature (Table 1) (2,(6)(7)(8). In cases reported by Schleich et (7) and Tremblay et al (6), the venous thrombotic events occurred intraoperatively and postoperatively.…”

Akute Embolie der A. brachialis bei einem Schwerbrandverletzten

“…Aufgrund der oben beschriebenen Hyperkoagulabilität durch ein Volumendefizit bei Verbrennungen > 10 % KOF erfolgt die Antikoagulation durch unfraktioniertes oder niedermolekulares Heparin in Standard-Dosierung wie bei unserer Patientin. Dies zeigt ein Vergleich unter deutschsprachigen Verbrennungszentren [15]. Eine Studie von Lin et al untersuchte den Wirkspiegel von niedermolekularen Heparinen (AntiXa-Spiegel) bei Verbrennungspatienten.…”