TOPLINE

Among hospitalized patients with burns receiving near-universal pharmacologic prophylaxis, clinically significant venous thromboembolism (VTE) occurred in 1.8% of the patients, with incidence reaching 7.4% among patients with burns covering > 20% of total body surface area (TBSA).

METHODOLOGY

• A retrospective cohort study assessed 1056 adult patients with burns (mean age, 54.7 years; mean TBSA burned, 8.1%; 62.3% Black individuals) admitted to a single academic burn center between 2012 and 2023.
• Patients were hospitalized for at least 48 hours; those receiving pharmacologic anticoagulation before admission or who died within 48 hours of admission were excluded. 
• The primary outcome was clinically significant VTE, defined as radiologically confirmed pulmonary embolism or deep vein thrombosis above the popliteal vein. 
• Low-molecular-weight heparin (LMWH) was the primary prophylactic agent in 75.6% of patients, whereas unfractionated heparin was used in 42.8%; skin grafting was performed for 64.6% of the patients.

TAKEAWAY

• Clinically significant VTE occurred in 1.8% of the patients.
• Incidence rose stepwise with burn severity, reaching 7.4% among patients with TBSA greater than 20%.
• In multivariable analysis, burns involving 10%-20% TBSA (odds ratio [OR], 3.33; 95% CI, 1.27-8.72; P = .01) and > 20% TBSA (OR, 7.17; 95% CI, 3.11-16.53; P < .01) were associated with a higher risk for VTE.
• Patients who developed VTE had a substantially longer hospital length of stay (mean, 66.2 days vs 14.8 days) and ICU length of stay (64.2 days vs 12.3 days) than those without VTE.

IN PRACTICE

"Our findings demonstrate a low overall VTE incidence of clinically significant %, with a higher incidence observed in patients with greater age, TBSA involvement, and prolonged ICU stay. This supports previous literature identifying age, burn severity, and critical illness as key contributors to thrombotic risk," the authors of the study wrote.

"The findings suggest that consistent, universal chemoprophylaxis may be effective even in the absence of protocolized anti-Xa monitoring," they added.

SOURCE

The study was led by Michael C. Edgar, MD, The Ohio State University, Columbus. It was published online on August 8, 2026, in Burns.

LIMITATIONS

The study was limited by nonuniversal VTE imaging, which may have resulted in missed asymptomatic or atypical events. Inconsistent availability of granular LMWH dosing and adherence data prevented the formal assessment of dosing adequacy and pharmacodynamic response. The small number of clinically significant VTE events limited the multivariable regression analysis, which may have limited the robustness of the findings; therefore, the analysis was considered exploratory.

DISCLOSURES

The study did not receive any funding. The authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.