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Venous Thromboembolism Prophylaxis in Underweight Hospitalized Patients

Douglas Buckheit1, Amanda Lefemine2, Diana M Sobieraj1,3

  • 1Department of Pharmacy Services, Hartford Hospital, Hartford, CT, USA.

Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
|June 3, 2021
PubMed

Insights

Reduced anticoagulant doses for venous thromboembolism (VTE) prophylaxis in underweight patients are common and linked to less major bleeding. This practice appears safe, with similar rates of other bleeding and VTE events compared to standard doses.

Area of Science:

  • Pharmacology
  • Internal Medicine
  • Hematology

Background:

  • Optimal anticoagulant dosing for venous thromboembolism (VTE) prophylaxis in underweight patients lacks robust evidence.
  • Underweight patients present unique challenges for standard VTE prophylaxis regimens.

Purpose of the Study:

  • To characterize anticoagulant dosing strategies in underweight VTE prophylaxis.
  • To compare bleeding and VTE incidence between standard and reduced anticoagulant doses in this population.

Main Methods:

  • Multi-center retrospective study of medicine patients weighing ≤45 kg receiving VTE prophylaxis.
  • Categorization into standard or reduced dose groups (unfractionated heparin or enoxaparin).
  • Comparison of major bleeding, clinically relevant non-major bleeding, and VTE incidence.

Main Results:

  • 40.7% of 300 patients received a reduced dose, most commonly enoxaparin 30 mg daily.
  • Standard dose was associated with significantly higher odds of major bleeding (OR 4.73).
  • Incidence of non-major bleeding and VTE was similar between reduced and standard dose groups.

Conclusions:

  • Reduced anticoagulant dosing for VTE prophylaxis in underweight hospitalized medicine patients is a frequent practice.
  • Dose reduction is associated with decreased major bleeding events.
  • Current reduced-dose strategies appear safe regarding other bleeding and VTE events.

Keywords:
anticoagulantsbleedingdeep venous thrombosispulmonary embolismthrombosis prophylaxis

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