Enoxaparin (Burns — VTE Prophylaxis)

How it works

It binds antithrombin and accelerates inhibition of factor Xa (and to a lesser extent thrombin), reducing thrombin generation and clot formation.

Prescribing in practice

• It is contraindicated in active major bleeding, and dose accumulation occurs in significant renal impairment, increasing bleeding risk.
• Burns patients have altered, frequently increased, drug clearance and oedema, so standard fixed prophylactic exposure may be inadequate and anti-Xa-guided dosing is sometimes used.
• Heparin-induced thrombocytopenia, though less common than with unfractionated heparin, must be considered if the platelet count falls.

Monitoring

Monitor renal function, platelet count, signs of bleeding, and anti-Xa activity where adequacy of prophylaxis is uncertain.

Counselling the patient

• This injection helps prevent blood clots while you are less mobile after your burn.
• Report unusual bruising, bleeding, or blood in urine or stool to the team.

Evidence & guidelines

Pharmacological VTE prophylaxis is recommended for at-risk hospitalised patients; burns are recognised as a state of elevated thrombotic risk.