Research Progress on Risk Factors and Prevention Strategies for Lower Extremity Deep Vein Thrombosis in Burn Patients
DOI:
https://doi.org/10.71321/nhz77q08Keywords:
Burn patients, Lower extremity deep vein thrombosis (DVT), Risk factorsAbstract
Objective：To systematically investigate the risk factors, pathological mechanisms, and prevention strategies for lower extremity deep vein thrombosis (DVT) in burn patients, and to evaluate the clinical value of a multidimensional prediction model.
Methods：A retrospective analysis of 320 burn patients from the Burn Department of the First Affiliated Hospital of Anhui Medical University was conducted, combined with a comprehensive literature review. Risk stratification, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were employed to identify critical factors and validate prevention efficacy.
Results：Key Risk Factors: Burn area ≥30% total body surface area (TBSA) (OR=3.12, 95% CI:1.85–5.26), wound infection (OR=2.78), prolonged bed rest ≥7 days (OR=2.45), and central venous catheterization (OR=2.15).Pathological Mechanisms: Inflammatory factor-mediated hypercoagulability, endothelial damage, and venous stasis synergistically drive thrombosis.Prevention Efficacy: Low molecular weight heparin (LMWH) reduced DVT risk by 64% (OR=0.36, P=0.004). Stratified strategies (early LMWH for high-risk patients + mechanical prophylaxis and stepwise rehabilitation for others) significantly lowered incidence.Prediction Model: A combined model integrating burn size, infection, immobilization, and catheterization achieved superior accuracy (AUC=0.85 vs. 0.72 for single-factor models).
Conclusion：DVT prevention in burn patients requires multidimensional risk identification, standardized LMWH application, and stratified management. A dynamic prediction model enables precise intervention and resource optimization. Future research should prioritize multicenter prospective validation and machine learning-driven early warning systems to further reduce thrombosis-related mortality.
References
[1] Akl, E. A., Ramly, E. P., Kahale, L. A., Yosuico, V. E. D., Barba, M., Sperati, F.,et al. (2014). Anticoagulation for people with cancer and central venous catheters. The Cochrane Database of Systematic Reviews, 10, CD006468. https://doi.org/10.1002/14651858.CD006468.pub5
[2] Ball, R. L., Keyloun, J. W., Brummel-Ziedins, K., Orfeo, T., Palmieri, T. L., Johnson, L. S., et al. (2020). Burn-Induced Coagulopathies: A Comprehensive Review. Shock (Augusta, Ga.), 54(2), 154–167. https://doi.org/10.1097/SHK.0000000000001484
[3] Bordeanu-Diaconescu, E.-M., Grosu-Bularda, A., Frunza, A., Grama, S., Andrei, M.-C., Neagu, T. P., et al. (2024). Venous Thromboembolism in Burn Patients: A 5-Year Retrospective Study. Medicina (Kaunas, Lithuania), 60(2), 258. https://doi.org/10.3390/medicina60020258
[4] Chen, X., Wang, K., Li, D., Zhao, M., Huang, B., Su, W., et al. (2022). Genetic and immune crosstalk between severe burns and blunt trauma: A study of transcriptomic data. Frontiers in Genetics, 13, 1038222. https://doi.org/10.3389/fgene.2022.1038222
[5] CRISTAL Study Group, Sidhu, V. S., Kelly, T.-L., Pratt, N., Graves, S. E., Buchbinder, R., Adie, S., et al. (2022). Effect of Aspirin vs Enoxaparin on Symptomatic Venous Thromboembolism in Patients Undergoing Hip or Knee Arthroplasty: The CRISTAL Randomized Trial. JAMA, 328(8), 719–727. https://doi.org/10.1001/jama.2022.13416
[6] Department of Anesthesia and Intensive Care, Emergency Clinical Hospital of Bucharest, Romania, Tiglis, M., Peride, I., Department of Nephrology, ”Carol Davila” University of Medicine and Pharmacy Bucharest, Romania, Neagu, T. P., Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, Romania, Niculae, A., Department of Nephrology, ”Carol Davila” University of Medicine and Pharmacy Bucharest, Romania, Lascar, I., & Department of Plastic Surgery and Reconstructive Microsurgery, ”Carol Davila” University of Medicine and Pharmacy Bucharest, Romania. (2022). Venous thromboembolism in burn patients – low incidence or underdiagnosis? Romanian Journal of Medical Practice, 17(4), 164–167. https://doi.org/10.37897/RJMP.2022.4.5
[7] Ding, K., Yan, W., Zhang, Y., Li, J., Li, C., & Liang, C. (2024). The safety and efficacy of NOACs versus LMWH for thromboprophylaxis after THA or TKA: A systemic review and meta-analysis. Asian Journal of Surgery, 47(10), 4260–4270. https://doi.org/10.1016/j.asjsur.2024.02.113
[8] Eck, R. J., Bult, W., Wetterslev, J., Gans, R. O. B., Meijer, K., Keus, F., et al. (2019). Intermediate Dose Low-Molecular-Weight Heparin for Thrombosis Prophylaxis: Systematic Review with Meta-Analysis and Trial Sequential Analysis. Seminars in Thrombosis and Hemostasis, 45(8), 810–824. https://doi.org/10.1055/s-0039-1696965
[9] Ho, K. M., Bham, E., & Pavey, W. (2015). Incidence of Venous Thromboembolism and Benefits and Risks of Thromboprophylaxis After Cardiac Surgery: A Systematic Review and Meta-Analysis. Journal of the American Heart Association, 4(10), e002652. https://doi.org/10.1161/JAHA.115.002652
[10] Jackson, B. S., & Pretorius, E. (2019). Pathological Clotting and Deep Vein Thrombosis in Patients with HIV. Seminars in Thrombosis and Hemostasis, 45(2), 132–140. https://doi.org/10.1055/s-0038-1676374
[11] Jayarajah, U., Basnayake, O., & Ekanayake, G. (2020). Critical care management in burns: A review of current evidence and guidelines - Part 2. Sri Lanka Journal of Surgery, 38(3). https://doi.org/10.4038/sljs.v38i3.8788
[12] Kruger, P. C., Eikelboom, J. W., Douketis, J. D., & Hankey, G. J. (2019). Deep vein thrombosis: Update on diagnosis and management. The Medical Journal of Australia, 210(11), 516–524. https://doi.org/10.5694/mja2.50201
[13] Lee, Y., Jehangir, Q., Li, P., Gudimella, D., Mahale, P., Lin, C.-H., et al. (2022). Venous thromboembolism in COVID-19 patients and prediction model: A multicenter cohort study. BMC Infectious Diseases, 22(1), 462. https://doi.org/10.1186/s12879-022-07421-3
[14] Li, D., Yuan, M., & Yang, H. (2022). Blood Cell Parameters Combined with Inflammatory Markers in the Early Diagnosis of Pulmonary Embolism. Cellular and Molecular Biology (Noisy-Le-Grand, France), 68(5), 177–185. https://doi.org/10.14715/cmb/2022.68.5.24
[15] Lu, R. P., Lin, F.-C., Ortiz-Pujols, S. M., Adams, S. D., Whinna, H. C., Cairns, B. A., et al. (2013). Blood utilization in patients with burn injury and association with clinical outcomes (CME). Transfusion, 53(10), 2212–2221; quiz 2211. https://doi.org/10.1111/trf.12057
[16] Pannucci, C. J., Osborne, N. H., & Wahl, W. L. (2011). Venous thromboembolism in thermally injured patients: Analysis of the National Burn Repository. Journal of Burn Care & Research: Official Publication of the American Burn Association, 32(1), 6–12. https://doi.org/10.1097/BCR.0b013e318204b2ff
[17] Peng, G., Wang, Q., Sun, H., Gan, L., Lu, H., Deng, Z., et al. (2021). Development and prospective validation of a novel risk score for predicting the risk of lower extremity deep vein thrombosis among multiple trauma patients. Thrombosis Research, 201, 116–122. https://doi.org/10.1016/j.thromres.2021.02.020
[18] Qian, X., Ge, Y., & Luo, J. (2024). Risk factors for deep vein thrombosis after traumatic lower extremity fracture: A systematic review and meta-analysis. Medicine, 103(23), e38439. https://doi.org/10.1097/MD.0000000000038439
[19] Roldan, C. J., & Paniagua, L. (2015). Central Venous Catheter Intravascular Malpositioning: Causes, Prevention, Diagnosis, and Correction. The Western Journal of Emergency Medicine, 16(5), 658–664. https://doi.org/10.5811/westjem.2015.7.26248
[20] Stanton, E. W., Manasyan, A., Thompson, C. M., Patel, G. P., Lacey, A. M., Travis, T. E., et al. (2024). Venous Thromboembolism Incidence, Risk Factors, and Prophylaxis in Burn Patients: A National Trauma Database Study. Journal of Burn Care & Research: Official Publication of the American Burn Association, irae171. https://doi.org/10.1093/jbcr/irae171
[21] Teja, B., Bosch, N. A., Diep, C., Pereira, T. V., Mauricio, P., Sklar, M. C., et al. (2024). Complication Rates of Central Venous Catheters: A Systematic Review and Meta-Analysis. JAMA Internal Medicine, 184(5), 474–482. https://doi.org/10.1001/jamainternmed.2023.8232
[22] Toker, S., Hak, D. J., & Morgan, S. J. (2011). Deep vein thrombosis prophylaxis in trauma patients. Thrombosis, 2011, 505373. https://doi.org/10.1155/2011/505373
[23] Tullie, S., Nicholson, T., Bishop, J. R. B., McGee, K. C., Asiri, A., Sullivan, J., et al. (2024). Severe thermal and major traumatic injury results in elevated plasma concentrations of total heme that are associated with poor clinical outcomes and systemic immune suppression. Frontiers in Immunology, 15, 1416820. https://doi.org/10.3389/fimmu.2024.1416820
[24] van Minnen, O., van den Bergh, W. M., Droogh, J. M., Koehorst, L., Lagrand, W. K., Raasveld, S. J., et al. (2022). Incidence and risk factors of deep vein thrombosis after extracorporeal life support. Artificial Organs, 46(9), 1893–1900. https://doi.org/10.1111/aor.14271
[25] Wei, Q., Wei, Z.-Q., Jing, C.-Q., Li, Y.-X., Zhou, D.-B., Lin, M.-B., et al. (2023). Incidence, prevention, risk factors, and prediction of venous thromboembolism in Chinese patients after colorectal cancer surgery: A prospective, multicenter cohort study. International Journal of Surgery (London, England), 109(10), 3003–3012. https://doi.org/10.1097/JS9.0000000000000553
[26] Yang, X., Li, H., Yu, L., Yu, T., Li, F., Yu, Z., et al. (2021). [Analysis of Influencing Factors for Postoperative Venous Thromboembolism of Thymic Malignancies]. Zhongguo Fei Ai Za Zhi = Chinese Journal of Lung Cancer, 24(7), 497–502. https://doi.org/10.3779/j.issn.1009-3419.2021.101.22
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