Impact of Heparin and Enoxaparin Anticoagulant Prophylaxis on Improving Acute Mortality in Burn Patients

Abstract

Burn patients have a higher chance of developing thromboembolic complications leading to worsened mortality rates so prophylactic anticoagulation is important. Anticoagulants such as enoxaparin, a low molecular weight heparin (LMWH), and unfractionated heparin (UFH) have been frequently used as chemical prophylactic treatments of thromboembolisms. Enoxaparin has been shown to have lower mortality and higher efficacy in surgical patients and coronary artery disease patients. The aim of the study is to assess mortality and compare the safety of enoxaparin and heparin in acute burn patients. A retrospective cohort study of 26572 burn patients was conducted using the TriNetX database. Patients were divided into two cohorts: those receiving only unfractionated heparin (Cohort 1) and those receiving only enoxaparin (Cohort 2) prophylaxis within 24 hours after burn injury. Cohorts were matched with 1:1 propensity score matching to correct for differences in age, gender, ethnicity, race, burn severity, inhalation injury, diabetes mellitus, acute myocardial infarction, stroke, and central line venous catheter placement. Outcomes assessed included mortality and deep vein thrombosis (DVT) within a month (30 days). After matching, the enoxaparin(n=7484) cohort showed significantly lower 30-day mortality (1.3%) compared to the UFH (n=7484) cohort (3.6%) (RR = 2.70, 95% CI: 2.15-3.40, p < 0.05). Kaplan-Meier analysis demonstrated a higher survival probability in the enoxaparin group (98.6% vs. 96.4%, p < 0.05). DVT risk was slightly higher with UFH but not statistically significant (RR = 1.18, 95% CI: 0.54-2.54, p = 0.68). Prophylactic anticoagulation with enoxaparin is associated with a significant lower 30-day mortality risk compared to unfractionated heparin.

Keywords: Burn patients; Enoxaparin; Mortality; Thromboembolism; Unfractionated heparin.