This study aims to compare the efficacy of anti-Xa based versus weight-based enoxaparin dosing and to evaluate anti-Xa levels as a predictive tool for clinical outcomes in burn patients

This study aims to compare the efficacy of anti-Xa based versus weight-based enoxaparin dosing and to evaluate anti-Xa levels as a predictive tool for clinical outcomes in burn patients, Patients will be randomized 1:1 to either anti-Xa-based or weight-based enoxaparin dosing.

Group 1 (weight-based):

• Enoxaparin (subcutaneously) adjusted for weight: 1mg/kg twice daily.
• For obese and morbidly obese patients, 1 mg/kg Q 12 h dose will be given up to weights of approximately 150 kg. The maximum dose of enoxaparin should be 150 mg SC Q 12 h.
• Patients weighing < 45 kg were not included in clinical trials; therefore, these patients should also be monitored using the low molecular weight heparin assay.
• No routine anti-Xa monitoring unless clinically indicated.

Group 2 (anti-Xa-based):

• Initial dose as standard: 1mg/kg twice daily; peak anti-Xa level measured 4 hours after third dose, Target: 0.2-0.4 IU/ml for prophylaxis.
• Adjustments: Increase by 10 mg if <0.2 IU/mL; decrease by 10 mg if >0.4 IU/ml.
• Re-check after 3 modified doses until the target level is achieved.
• Prophylaxis continues until mobilization or discharge.

Inclusion Criteria:

1. Adults (≥21 years) admitted to the burn unit with thermal burns ≥20% TBSA and < 60%.
2. Admission to BICU within 48 hours of burn injury.
3. Indication for VTE prophylaxis (e.g., immobilized, surgical intervention).
4. Ability to provide informed consent

Exclusion Criteria:

1. Pre-existing coagulopathy or anticoagulant therapy prior to injury.
2. Patients with severe comorbidities (e.g., end-stage renal failure, advanced malignancy, hepatic disease).
3. Need for therapeutic anticoagulant therapy.
4. patients with extremes of weight, (45kg >=weight >= 150kg).