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Clinical Experience With Pharmacological Venous Thromboembolism Prophylaxis in the Underweight and Critically Ill
Christopher Carter1, Jennifer Bushwitz2, Mollie Gowan2
1Barnes-Jewish Hospital, St Louis, MO, USA SSM Health St Clare Hospital, Fenton, MO, USA christopher_carter@ssmhc.com.
Insights
Optimal venous thromboembolism (VTE) prophylaxis for underweight, critically ill patients remains unclear. This study found no significant difference in VTE rates between standard and reduced doses, but standard doses showed higher bleeding risks.
Area of Science:
- Critical care medicine
- Pharmacology
- Thrombosis research
Background:
- Optimal pharmacological prophylaxis for venous thromboembolism (VTE) in underweight, critically ill patients is not established.
- Underweight critically ill patients present unique challenges for VTE risk assessment and prophylaxis.
Purpose of the Study:
- To investigate VTE prophylaxis prescribing patterns in underweight critically ill patients (≤50 kg or BMI ≤18.5 kg/m²).
- To determine the prevalence of VTE and bleeding events in this patient cohort based on prophylaxis dosage.
Main Methods:
- Retrospective cohort study design.
- Inclusion of 295 underweight, critically ill patients receiving VTE prophylaxis for ≥48 hours.
- Comparison of outcomes between standard- and reduced-dose VTE prophylaxis regimens.
Main Results:
- The majority (79.7%) of underweight patients received unfractionated heparin (5000 units TID).
- No statistically significant difference in clinically relevant VTE prevalence between reduced- and standard-dose groups (4.4% vs 5.6%, P = 1.00).
- A higher proportion of bleeding events was observed in the standard-dose group (11.2%) compared to the reduced-dose group (6.7%), though not statistically significant (P = 0.4).
Conclusions:
- Empirical dose reductions for VTE prophylaxis are infrequently utilized in underweight, critically ill patients.
- Further research is warranted to evaluate the safety and efficacy of reduced-dose VTE prophylaxis in this population.
- Determining if reduced doses can achieve acceptable efficacy with lower bleeding risks is crucial.
Background:
The optimal regimen for pharmacological prophylaxis of venous thromboembolism (VTE) in underweight, critically ill patients is unknown.
Objective:
To describe prescribing patterns for VTE prophylaxis in underweight (≤50 kg or body mass index ≤18.5 kg/m(2)), critically ill patients and identify the prevalence of VTE and bleeding.
Methods:
This was a retrospective cohort study that included patients who received standard- or reduced-dose VTE prophylaxis for ≥48 hours.
Results:
A total of 295 individuals were included in the study. The majority of underweight patients in this study (79.7%) received unfractionated heparin, 5000 units 3 times daily. No statistically significant difference in the prevalence of clinically relevant VTEs between the reduced- and standard-dose groups was observed (4.4% vs 5.6%, P = 1.00), but a higher proportion of bleeding events was identified within the standard-dose group (6.7% vs 11.2%, P = 0.4).
Conclusions:
Empirical dose reductions of VTE prophylaxis are infrequently used in underweight, critically ill patients. Further studies need to be conducted that assess the safety and efficacy of reduced-dose VTE prophylactic regimens in this population to determine if acceptable efficacy can be achieved, with lower risks of bleeding.
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