Venous Thromboembolism Prophylaxis in Burn Patients: A 12-Year Retrospective Cohort Study in the Era of “Trauma Dosing” Low Molecular Weight Heparin

Venous thromboembolism is a recognized complication of burn injury, yet the contemporary incidence in the setting of routine pharmacologic prophylaxis remains uncertain. We conducted a twelve-year retrospective cohort study of adult patients admitted to a single academic burn center between 2012 and 2023. The primary outcome was clinically significant venous thromboembolism, defined as pulmonary embolism or deep vein thrombosis above the popliteal vein confirmed by imaging. Univariable and multivariable logistic regression were performed to identify factors associated with venous thromboembolism. A total of 1,056 patients met inclusion criteria. The mean age was 54.7 years, and the mean total body surface area (TBSA) burned was 8.1%. Nineteen patients developed clinically significant venous thromboembolism, corresponding to an overall incidence of 1.8%. Incidence increased stepwise with burn severity, reaching 7.4% among patients with greater than 20% TBSA. Increasing age (1.01, 1.00-1.06), and intensive care unit length of stay (1.02, 1.00-1.03) were independently associated with venous thromboembolism on multivariable analysis. Over the study period, venous thromboembolism incidence decreased, alongside an increase in institutional use of low molecular weight heparin; however, this decline was not statistically significant. In a modern burn population receiving near-universal pharmacologic prophylaxis, the incidence of clinically significant venous thromboembolism was low. These findings support consistent prophylaxis in hospitalized burn patients while highlighting the need for prospective studies to refine risk stratification and dosing strategies.