P23. Venous Thromboembolism Prophylaxis in Burn Patients

PURPOSE: Venous thromboembolism (VTE) in burn patients presents unique challenges in terms of pathophysiology and management. This study aims to investigate VTE prophylaxis outcomes in this population to inform future management, as specific recommendations are currently lacking. METHODS: We analyzed the US National Trauma Data Bank (NTDB) for burn patients from 2017-2021 using ICD-10 event codes. Primary outcomes included VTE incidence, deep venous thrombosis, and pulmonary embolism. Secondary outcomes were blood transfusion and return to the operating room due to hemorrhage. Multivariable regressions assessed the relationship between VTE prophylaxis types, timing, and VTE incidence, controlling for covariates. RESULTS: Among 326,614 burn patients, 5,604 (1.7%) experienced VTE. Most patients did not receive VTE prophylaxis (54.1%). Among those who did, LMWH (37.9%) and unfractionated heparin (4.1%) were common. Controlling for covariates, heparin and LMWH were associated with increased VTE risk (heparin: OR=1.8, 95% CI 1.3-2.5, p<.001; LMWH: OR=1.5, 95% CI 1.2-1.8, p<.001). Delayed prophylaxis initiation correlated with higher VTE odds (OR=1.04, 95% CI 1.03-1.07, p<.001). Neither prophylaxis type nor timing affected blood transfusion need. Heparin increased the odds of returning to the OR for bleeding-related complications (p<.001). CONCLUSION: Most burn patients did not receive VTE prophylaxis, and surprisingly, those who did had higher VTE rates, despite covariate adjustments. Among prophylaxis recipients, unfractionated heparin was associated with increased VTE and surgical bleeding complications compared to LMWH. Delayed prophylaxis initiation increased VTE risk. These findings emphasize the need for specialized VTE prevention guidelines for burn patients to enhance their care and outcomes.