title: An analysis of deep vein thrombosis in burn patients (part II): A randomized and controlled study of thrombo-prophylaxis with low molecular weight heparin.
abstract: BACKGROUND
  Morbidity and mortality from venous thrombo-embolism (VTE) remains a significant problem for trauma and medical patients and there are established guidelines for prophylaxis in these patients. However, the efficacy and safety of VTE prophylaxis in thermally injured patients continue to be elusive as it has never been studied in a prospective, randomized fashion. Selective use of VTE prophylaxis, for high risk patients, is practiced by some burn units even if objective evidence is lacking for majority of risk factors enunciated in burn patients. Differing demographics and wound management techniques are other confounding factors mandating more prospective studies to evaluate the need and role of chemoprophylaxis for deep vein thrombosis (DVT) prevention in burn patients. Ours is the first prospective, randomized, controlled study which seeks to identify risk factors for DVT in our patients, and evaluate the role of routine chemoprophylaxis and its complications.
  
  
  METHODS
  The study design (sample size, inclusion/exclusion criteria, randomization, methodology and statistical methods) is detailed in part-1 of this two part manuscript.
  
  
  RESULTS
  Doppler ultrasound (DUS) identified DVT in four out of 50 patients (8% incidence) forming the control group. DVT was not detected in any of the patients on prophylaxis (0% incidence). This difference was found to be statistically significant (p value-0.021). Patients with DVT had significantly higher %TBSA, prolonged immobility and a longer duration of stay as compared to patients without DVT in the control group. Only one patient on enoxaparin prophylaxis developed mild epistaxis which resolved spontaneously. Fifteen patients died during the study out of which two had DVT but none showed autopsy evidence of pulmonary embolism.
  
  
  CONCLUSIONS
  With a moderate risk of developing DVT (8%) and a complication rate of only 2% with chemoprophylaxis, we feel that routine prophylaxis has the potential to decrease the incidence of VTE, without associated complications, in the moderate to high risk category.
authors.affiliation: Department of Burns & Plastic Surgery, New Delhi 110 Q2 002, India; Associated Maulana Azad Medical College, New Delhi 110 002, India. Electronic address: rbahuja@gmail.com.
authors.forename: Rajeev B
authors.initials: RB
authors.lastname: Ahuja
authors.affiliation: Department of Burns & Plastic Surgery, New Delhi 110 Q2 002, India; Associated Maulana Azad Medical College, New Delhi 110 002, India.
authors.forename: Priya
authors.initials: P
authors.lastname: Bansal
authors.affiliation: Department of Radiology, Lok Nayak Hospital, New Delhi 110 002, India; Associated Maulana Azad Medical College, New Delhi 110 002, India.
authors.forename: Gaurav S
authors.initials: GS
authors.lastname: Pradhan
authors.affiliation: Associated Maulana Azad Medical College, New Delhi 110 002, India; Department of Biochemistry, G.B. Pant Hospital, New Delhi 110 002, India.
authors.forename: Manju
authors.initials: M
authors.lastname: Subberwal
mesh_terms: D000293:Adolescent; D000328:Adult; D001830:Body Surface Area; D002056:Burns / Q000150:complications / Q000628:therapy*; D019468:Disease Management; D017984:Enoxaparin / Q000627:therapeutic use*; D004844:Epistaxis / Q000139:chemically induced; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D012307:Risk Factors; D013997:Time Factors; D015599:Trauma Severity Indices; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D017984:Enoxaparin; D005343:Fibrinolytic Agents
keywords: DVT in burns; DVT prophylaxis; Deep vein thrombosis