Burn specific venous thromboembolism prophylaxis: a two-year quality improvement project

Abstract Patients with major burns are at high risk of venous thromboembolism. In 2022, a new prophylaxis guideline was introduced for adults with burns >20% total body surface area: enoxaparin 40mg twice daily, renally and weight adjusted. This quality improvement study assessed compliance and outcomes by comparing patients admitted post-guideline (January 2022–December 2023) to a pre-guideline cohort (July 2019–June 2021) who received enoxaparin 40mg daily. Among 138 patients (77% male, median age 43 years, median % total body surface area 35), 57 were treated pre-guideline and 45 post, with no major differences between groups. Pre-guideline, 5 patients developed venous thromboembolic complications (2 pulmonary emboli, 3 deep vein thromboses), versus 3 incidental thromboembolisms (1 pulmonary emboli, 2 deep vein thromboses) post-guideline. Transfusion for bleeding was similar across groups, but major bleeding affecting dermal substitute application increased from 1 case (2%) pre-guideline to 7 cases (15%) post-guideline, but this difference was not statistically significant. To mitigate this, intravenous tranexamic acid and increased transfusion rates were implemented after 12 months, eliminating major bleeding events in the subsequent period. Overall, 88% of patients received venous thromboembolic prophylaxis in line with the guideline. Despite an initial increase in bleeding complications, intraoperative adjustments resolved these issues, demonstrating a learning curve. The guideline was successfully implemented and appears effective in reducing venous thromboembolic risk with acceptable complications.