Burn-Specific Venous Thromboembolism Prophylaxis: A 2-Year Quality Improvement Project

Area of Science:

• Burn Care
• Thromboembolism Prevention
• Quality Improvement

Background:

• Major burns increase venous thromboembolism (VTE) risk.
• A 2022 guideline recommended enoxaparin for VTE prophylaxis in adults with >20% total body surface area burns.
• Previous prophylaxis involved enoxaparin 40mg daily.

Purpose of the Study:

• To assess compliance with the 2022 VTE prophylaxis guideline.
• To compare VTE complication rates and bleeding events pre- and post-guideline implementation.
• To evaluate the effectiveness and safety of the new guideline.

Main Methods:

• Quality improvement study comparing two cohorts: pre-guideline (July 2019-June 2021) and post-guideline (January 2022-December 2023).
• Patients received enoxaparin 40mg daily (pre) vs. twice daily, renally and weight adjusted (post).
• Data collected on VTE events, bleeding complications, and prophylaxis compliance.

Main Results:

• 88% of patients received guideline-compliant VTE prophylaxis post-implementation.
• VTE complications decreased from 5 pre-guideline to 3 post-guideline.
• Major bleeding affecting dermal substitute application increased from 2% to 15% initially, but was resolved with interventions.

Conclusions:

• The 2022 VTE prophylaxis guideline was successfully implemented in major burn patients.
• The guideline appears effective in reducing VTE risk with acceptable complications after initial adjustments.
• Intraoperative interventions, including tranexamic acid, mitigated bleeding risks, demonstrating a learning curve.