New Oral Anticoagulants for Prevention of Complications of Venous Thromboembolism in Burn Patients

The development of new oral anticoagulants (NOACs) has led to their wider use in clinical practice for prevention of complications of venous thromboembolism (VTE) , including in patients with thermal injury , since there is no need for strict control over the hemostatic system (which simplifies the work of the physician) and it became possible to abandon the invasive use of heparins (which makes life easier for the patient). However, in the indications for the use of NOACs schemes for their use in patients with severe thermal injury are not presented , which forces them to be used “off lebel", especially in the development of thrombocytopenic conditions. We used dabigatran etexilate (DE) for prevention of systemic pathology hemostasis in burn patients.

Objective: To assess the clinical efficacy and state of hemostasis parameters in burn patients who received DE for prevention of venous thromboembolic complications.

Materials and Methods: The study included 30 burn patients who were treated at the burn center in the period from 2015 to 2017 with an area of lesion of the skin more than 20% of the body surface (TSBA). After the release of patients from shock for the prevention of VTE, patients received DE of 110 mg 2 times every day. The duration of the intake of DE was on average 34 ± 5 days. To evaluate the efficacy of the treatment was determined following coagulation test: APTT, PT, INR, fibrinogen, thrombin time blood once a week during the observation. All patients for the diagnosis of VTE was performed on doppler ultrasound.

Results: Of the 30 patients who were under observation, three patients were diagnosed with DVT (10%). These patients were older (mean age 54.67 ± 11.59 years) compared with patients without VTE (mean age 33.67 ± 8.37 years). The differences are statistically significant (p = 0.018652, t = 2.5, with f = 28). Also, patients with VTE had a large burn area (48.33 ± 7.64% PT), the burn area in patients without VTE 32.41 ± 8.97% PT. The differences are statistically significant (p = 0.009292, t = 2, 8 with f = 28). In blood tests, there were no sharp fluctuations in the indices of INR and fibrinogen. The APTT level in all patients did not exceed the upper limit of the reference value. There was a decrease in PT to the lower limits of the norm (not less than 70%) in 6 patients. Thrombin time responded to the use of DE in a wide range from 16.5 to 104.2 seconds. No clinically significant bleeding and pulmonary thromboembolism associated with the administration of DE were noted.

Conclusion: As a means of preventing VTE in prophylactic dosage of dabigatran etexilate it has certain advantages: oral administration, a fixed dose for patients with different body weight, there is no need for routine monitoring. However development thrombotic complications in 3 patients who are at extremely high risk of developing VTE, and talk about the need for individual selection of the NOACs dose.