500 Anticoagulant Use Is Associated with Different Outcomes in Pediatric and Adult Burn Patients

TL;DR

This study compares anticoagulant use in pediatric and adult burn patients, finding significant differences in outcomes like bleeding and mortality.

Contribution

The study identifies distinct patterns and outcomes of anticoagulant use in pediatric versus adult burn patients, highlighting a need for pediatric-specific guidelines.

Findings

Adult burn patients had significantly higher rates of VTE, bleeding events, and mortality compared to pediatric patients.

Heparins were the most commonly used anticoagulant in both adult and pediatric burn patients.

Anticoagulant treatment was more frequently administered to adult burn patients than to pediatric patients.

Abstract

Anticoagulation therapy in pediatric burn patients remains an under-researched area of burn medicine lacking guidelines or scores to establish standardized therapy. The aim of this study is to evaluate the use of anticoagulants in pediatric compared to adult burn patients and to identify the most frequently used drug classes.

A large database was searched to create two cohorts of burn patients with more than 10% TBSA. Pediatric patients (age 0-17) were compared to adult burn patients (18-100) after propensity score matching was carried out for gender, ethnicity, and race.

Venous thromboembolic events (VTE), mortality, and bleeding events were defined as outcome variables. Data analysis was performed with the tools of descriptive statistics. Risk and odds ratios were presented with significance set at p< 0.05. We also examined and compared the number of cases in which burn victims were treated with anticoagulants and the frequency distribution of different anticoagulant classes. Anticoagulants were divided into 4 groups: heparins, factor Xa-inhibitors, vitamin K antagonists, and thrombin inhibitors.

After propensity score matching, each of the cohorts included 5630 patients. 5.5% and therefore significantly (p< 0.001) more adult patients showed thromboembolic complications compared to 1.4% of pediatric patients, with RR 0.26 (95% CI 0.20-0.33) and OR 0.24 (95% CI 0.19-0.31). Bleeding events occurred in 4.9% of adult patients, which is more than twice as common as in pediatric patients (2.1%), with RR 0.42 (95% CI 0.34-0.52) and OR 0.41 (95% CI 0.33-0.51). With 5.8% vs. 1.5% deaths in adults compared to pediatrics, mortality was also significantly higher (p< 0.001) in the adult cohort, showing RR of 0.27 (95% CI 0.21-0.34) and OR of 0.26 (95% CI 0.20-0.32).

While 33.4% of adult burn patients were treated with anticoagulants within the first week after burn, only 6.7% of the pediatric burn population were treated. Further, the most frequently used drug group in both adult and pediatric burn patients was heparins, given in over 90% of the cases. Other drug classes were used in less than 10% of cases.

Anticoagulant treatment within the first 7 days after burn is more likely administered to adults than to pediatric patients. However, in most cases, heparins were the drug of choice in both groups. Bleeding events, the occurrence of VTE, and mortality was significantly higher in adult burn patients.

The discrepancy in the use of anticoagulants between adults and pediatrics in burn care highlights the need for larger studies to develop standardized guidelines for the use of different anticoagulants in pediatric burn patients.