Application of standardized venous thromboembolism prevention program in burn patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Yanqiong , HUANG Jianqiong ,  XU Xuewen ,  CHEN Junjie , WU Zhihui , GAO Jiali , TANG Jing , HU Min , YU Xia

Department of Aesthetic Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

XU Xuewen, Email: xxw_0286@163.com; CHEN Junjie, Email: cjjemail@163.com

Keywords：

Venous thromboembolism; burn; prevention; complication

DOI：

10.7507/1002-1892.201812061

Video：

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Objective To develop a standardized venous thromboembolism (VTE) prevention program for burn patients and verify its safety and effectiveness by comparing with traditional thrombus prophylaxis.Methods All burn patients admitted and met selection criteria betweem April 2017 and September 2018 were included. Patients between January 2018 and September 2018 were included as the interventional group to implement standardized VTE prevention programs, while patients between April 2017 and December 2017 were included as the control group and traditional active and passive exercises were used to prevent VTE. There was no significant difference in the age, gender, ethnic group, marriage, education, occupation, type and site of the injury, burn area, operation time, and hospital stay between the two groups (P>0.05), which was comparable. The incidence of VTE, number of cases of tissue or organ hemorrhage, survival rate of skin grafting, and time of wound healing were compared.Results The incidence of VTE was obviously lower in the interventional group (1.56%, 1/64) than in the control group (10.17%, 6/59) (χ²=−2.05, P=0.04). No bleeding occurred in any tissue or organ in the two groups. The survival rate of skin grafting and the time of wound healing were 89.06% (57/64) and (11.78±3.08) days respectively in the interventional group and 91.53% (54/59) and (11.66±2.30) days respectively in the control group; and the differences between the two groups were not statistically significant (χ²=0.21, P=0.65; t=−0.22, P=0.83).Conclusion The standardized VTE prevention program can effectively prevent the occurrence of VTE, and its safety is relatively high.

Citation： WANG Yanqiong, HUANG Jianqiong, XU Xuewen, CHEN Junjie, WU Zhihui, GAO Jiali, TANG Jing, HU Min, YU Xia. Application of standardized venous thromboembolism prevention program in burn patients. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(6): 726-729. doi: 10.7507/1002-1892.201812061 Copy

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2.	Goldhaber SZ. Evolving concepts in thrombolytic therapy for pulmonary embolism. Chest, 1992, 101(4 Suppl): 183S-185S.
3.	Abedi N, Papp A. A survey of current practice patterns in prophylaxis against venous thromboembolism (VTE) and gastrointestinal (GI) ulceration among Canadian burn centers. Burns, 2011, 37(7): 1182-1186.
4.	Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest, 2008, 133(6 Suppl): 381S-453S.
5.	Wahl WL, Brandt MM, Ahrns KS, et al. Venous thrombosis incidence in burn patients: preliminary results of a prospective study. J Burn Care Rehabil, 2002, 23(2): 97-102.
6.	Faucher LD, Conlon KM. Practice guidelines for deep venous thrombosis prophylaxis in burns. J Burn Care Res, 2007, 28(5): 661-663.
7.	Bouras G, Burns EM, Howell AM, et al. Risk of post-discharge venous thromboembolism and associated mortality in general surgery: A population-based cohort study using linked hospital and primary care data in England. PLoS One, 2015, 10(12): e0145759.
8.	Khalafallah AA, Kirkby BE, Wong S, et al. Venous thromboembolism in medical patients during hospitalisation and 3 months after hospitalisation: a prospective observational study. BMJ Open, 2016, 6(8): e012346.
9.	高凤英, 习耀锋, 郑明霞, 等. 烧伤患者深静脉血栓发生情况及其影响因素. 中华烧伤杂志, 2016, 32(3): 176-180.
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11.	范宝玉, 王娟, 赵海磊. 皮下注射低分子肝素钙对烧伤植皮后深静脉血栓形成、创面愈合及感染率的影响. 感染、炎症、修复, 2017, 18(3): 141-144.
12.	马彩虹, 贺立新, 曹玉珏, 等. 皮下注射低分子肝素钙预防烧伤植皮后深静脉血栓形成的临床观察. 感染、炎症、修复, 2014, 15(2): 98-100.
13.	Bushwitz J, LeClaire A, He J, et al. Clinically significant venous thromboembolic complications in burn patients receiving unfractionated heparin or enoxaparin as prophylaxis. J Burn Care Res, 2011, 32(6): 578-582.
14.	Lin H, Faraklas I, Saffle J, et al. Enoxaparin dose adjustment is associated with low incidence of venous thromboembolic events in acute burn patients. J Trauma, 2011, 71(6): 1557-1561.
15.	Henke PK, Arya S, Pannucci C, et al. Procedure-specific venous thromboembolism prophylaxis: a paradigm from colectomy surgery. Surgery, 2012, 152(4): 528-534.
16.	Turpie AG, Bauer KA, Caprini JA, et al. Fondaparinux combined with intermittent pneumatic compression vs. intermittent pneumatic compression alone for prevention of venous thromboembolism after abdominal surgery: a randomized, double-blind comparison. J Thromb Haemost, 2007, 5(9): 1854-1861.
17.	Pannucci CJ, Obi AT, Timmins BH, et al. Venous thromboembolism in patients with thermal injury: A review of risk assessment tools and current knowledge on the effectiveness and risks of mechanical and chemical prophylaxis. Clin Plast Surg, 2017, 44(3): 573-581.
18.	Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest, 2016, 149(2): 315-352.
19.	张竞, 张金庆, 郭盛杰, 等. 不同频次使用间歇式充气加压装置对预防关节置换术后下肢深静脉血栓形成的效果研究. 中华骨与关节外科杂志, 2016, 9(4): 335-338.
20.	Bolliger D, Szlam F, Azran M, et al. The anticoagulant effect of protamine sulfate is attenuated in the presence of platelets or elevated factor Ⅷ concentrations. Anesth Analg, 2010, 111(3): 601-608.
21.	王国栋, 张元民, 赵晓伟, 等. 利伐沙班对初次行人工全膝关节置换术后隐性失血及输血率的影响. 中国修复重建外科杂志, 2012, 26(11): 1306-1309.
22.	Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e195S-e226S.

1. Office of the Surgeon General (US), National Heart, Lung, and Blood Institute (US). The surgeon general’s call to action to prevent deep vein thrombosis and pulmonary embolism. Office of the Surgeon General (US), 2008.
2. Goldhaber SZ. Evolving concepts in thrombolytic therapy for pulmonary embolism. Chest, 1992, 101(4 Suppl): 183S-185S.
3. Abedi N, Papp A. A survey of current practice patterns in prophylaxis against venous thromboembolism (VTE) and gastrointestinal (GI) ulceration among Canadian burn centers. Burns, 2011, 37(7): 1182-1186.
4. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest, 2008, 133(6 Suppl): 381S-453S.
5. Wahl WL, Brandt MM, Ahrns KS, et al. Venous thrombosis incidence in burn patients: preliminary results of a prospective study. J Burn Care Rehabil, 2002, 23(2): 97-102.
6. Faucher LD, Conlon KM. Practice guidelines for deep venous thrombosis prophylaxis in burns. J Burn Care Res, 2007, 28(5): 661-663.
7. Bouras G, Burns EM, Howell AM, et al. Risk of post-discharge venous thromboembolism and associated mortality in general surgery: A population-based cohort study using linked hospital and primary care data in England. PLoS One, 2015, 10(12): e0145759.
8. Khalafallah AA, Kirkby BE, Wong S, et al. Venous thromboembolism in medical patients during hospitalisation and 3 months after hospitalisation: a prospective observational study. BMJ Open, 2016, 6(8): e012346.
9. 高凤英, 习耀锋, 郑明霞, 等. 烧伤患者深静脉血栓发生情况及其影响因素. 中华烧伤杂志, 2016, 32(3): 176-180.
10. Guyatt GH, Akl EA, Crowther M, et al. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): 7S-47S.
11. 范宝玉, 王娟, 赵海磊. 皮下注射低分子肝素钙对烧伤植皮后深静脉血栓形成、创面愈合及感染率的影响. 感染、炎症、修复, 2017, 18(3): 141-144.
12. 马彩虹, 贺立新, 曹玉珏, 等. 皮下注射低分子肝素钙预防烧伤植皮后深静脉血栓形成的临床观察. 感染、炎症、修复, 2014, 15(2): 98-100.
13. Bushwitz J, LeClaire A, He J, et al. Clinically significant venous thromboembolic complications in burn patients receiving unfractionated heparin or enoxaparin as prophylaxis. J Burn Care Res, 2011, 32(6): 578-582.
14. Lin H, Faraklas I, Saffle J, et al. Enoxaparin dose adjustment is associated with low incidence of venous thromboembolic events in acute burn patients. J Trauma, 2011, 71(6): 1557-1561.
15. Henke PK, Arya S, Pannucci C, et al. Procedure-specific venous thromboembolism prophylaxis: a paradigm from colectomy surgery. Surgery, 2012, 152(4): 528-534.
16. Turpie AG, Bauer KA, Caprini JA, et al. Fondaparinux combined with intermittent pneumatic compression vs. intermittent pneumatic compression alone for prevention of venous thromboembolism after abdominal surgery: a randomized, double-blind comparison. J Thromb Haemost, 2007, 5(9): 1854-1861.
17. Pannucci CJ, Obi AT, Timmins BH, et al. Venous thromboembolism in patients with thermal injury: A review of risk assessment tools and current knowledge on the effectiveness and risks of mechanical and chemical prophylaxis. Clin Plast Surg, 2017, 44(3): 573-581.
18. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest, 2016, 149(2): 315-352.
19. 张竞, 张金庆, 郭盛杰, 等. 不同频次使用间歇式充气加压装置对预防关节置换术后下肢深静脉血栓形成的效果研究. 中华骨与关节外科杂志, 2016, 9(4): 335-338.
20. Bolliger D, Szlam F, Azran M, et al. The anticoagulant effect of protamine sulfate is attenuated in the presence of platelets or elevated factor Ⅷ concentrations. Anesth Analg, 2010, 111(3): 601-608.
21. 王国栋, 张元民, 赵晓伟, 等. 利伐沙班对初次行人工全膝关节置换术后隐性失血及输血率的影响. 中国修复重建外科杂志, 2012, 26(11): 1306-1309.
22. Kahn SR, Lim W, Dunn AS, et al. Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 2012, 141(2 Suppl): e195S-e226S.

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