Comparison of the Efficacy and Safety for Different Regimen of Venous Thromboembolism Pharmacoprophylaxis Among Severely Burn Patients
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 20
- Locations
- 1
- Primary Endpoint
- Adverse effects in surgical outcomes (i.e. Graft loss, donor site morbidity, requirement of hemostatic intervention).
Study Overview
Brief Summary
This study aims to assess the feasibility and safety of VTE prophylaxis for 3 modality regimens (Unfractionated heparin 5000 U SQ q8 hours, Enoxaparin 40 mg SQ q24 hours or Enoxaparin 30 mg SQ q12 hours) in adult patients (≥18 y/o) with severely burn injuries (BSA≥20%) by measuring the bleeding incidence and VTE events.
Detailed Description
This is a pilot , randomized control trial-Open label, prospective trial in tertiary academic hospitals for patient admitted to burn ICU for at least 24 hours of injury or transferred from other hospital(s) within 7 days of injury. Each patient admitted meets the inclusion criteria will be randomize by block randomization to either receive heparin 5000 units S.C. TID, enoxaparin 40 mg S.C. OD, or Enoxaparin 30 mg S.C. BID. VTE prophylaxis should be started within 36 hours of injury, if the patient is transferred from another facility, VTE prophylaxis should be started immediately unless contraindicated. All patients should undergo diagnostic ultrasound at baseline ( before starting the prophylaxis) to assess any presence of DVT and as clinically indicated for clinical suspicion for VTE thereafter until discharge, an urgent spiral CTA chest will be requested on clinical suspicion for PE. Anti Xa factor will be monitored at day 3, and weekly thereafter until discharge unless there is active bleeding or high clinical suspicion for bleeding. Will follow-up patient until discharge from ICU, developed VTE requiring treatment (switch to treatment dose), developed HIT or death.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Prevention
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Burn ICU admitted adult patients, age ≥ 18 years old.
- •Body Mass Index of 18.5 to < 40 kg/m
- •TBSA of 20% or more.
Exclusion Criteria
- •VTE history.
- •Death within 24 hours of injury.
- •Burn injuries combined with trauma requiring withholding pharmacoprophylaxis more than 48 hours.
- •Coagulopathy (INR > 1.7, PTT> 2 times upper normal limit, platelet < 50k mm3)
- •Patient with positive baseline US for VTE.
- •Heparin induced thrombocytopenia (HIT).
- •Active bleeding.
- •Patients with CrCl of 30 ml/min or less.
- •Patients using anticoagulation treatment dose for other indications.
Arms & Interventions
Unfractionated Heparin (UFH) 5000 U q8 hours
Severely burn injuries (BSA≥20%) will receive Unfractionated Heparin (UFH) 5000 U q8 hours as pharmacological VTE prophylaxis
Intervention: Unfractionated heparin 5000 U q8 hours (Drug)
Enoxaparin 40 mg q24 hours
Severely burn injuries (BSA≥20%) will receive Enoxaparin 40 mg q24 hours as pharmacological VTE prophylaxis
Intervention: Enoxaparin 40 mg q24 hours (Drug)
Enoxaparin 30 mg q12 hours
Severely burn injuries (BSA≥20%) will receive Enoxaparin 30 mg q12 hours as pharmacological VTE prophylaxis
Intervention: Enoxaparin 30 mg q12 hours (Drug)
Outcomes
Primary Outcomes
Adverse effects in surgical outcomes (i.e. Graft loss, donor site morbidity, requirement of hemostatic intervention).
Time Frame: Through study completion, an average of 2 years
Daily assessment of donor site and graft site bleeding/failure. Graft site bleeding defined as bleeding at skin graft recipient site that requires premature wound exploration ( before 3 days postoperatively), bed side or operating room intervention to stop bleeding ( stitching, hemostatic agent or cauterization) with or without blood transfusion. Donor site bleeding/hematoma is any bleeding leading to a drop in hemoglobin \> 2 grams, hemodynamic instability or bleeding requiring urgent transfusion. Graft failure due to hematoma that require re-grafting or more than 50% of the graft site. Enoxaparin should be held 12 hours and unfractionated heparin 3-4 hours before percutaneous tracheostomy OR epidural catheter if indicated.
Recruitment and consent rates
Time Frame: Through study completion, an average of 2 years
To assess the recruitment and consent rate to evaluate trial feasibility
Incidence of bleeding events (major and minor)
Time Frame: Through study completion, an average of 2 years
Daily assessment of major and minor Bleeding. Bleeding will classified into major and minor bleeding. Major bleeding defined as clinically overt bleeding associated with a fall ≥Hb 20g/L, transfusion of ≥2U PRBC or whole blood, retroperitoneal or intracranial bleeding or requiring urgent medical intervention. Minor bleeding defined as those not fulfilling the criteria of major or clinically significant bleeding.
Secondary Outcomes
- Incidence of Heparin induced thrombocytopenia (HIT).(Through study completion, an average of 2 years)
- Target anti Xa factor for enoxaparin or unfractionated heparin in severely burn patients.(Through study completion, an average of 2 years)
- Number of days that patients stay in hospital(Through study completion, an average of 2 years)
- Number of patients died within intensive care unit stay(Through study completion, an average of 2 years)
- Incidence of VTE events (Symptomatic)(Through study completion, an average of 2 years)
Investigators
KHALID ALSULAIMAN
Dr. Khalid Al Sulaiman, Consultant, Critical Care Clinical Pharmacist
King Abdullah International Medical Research Center