Venous Thromboembolism Prophylaxis in Low Body Weight Critically Ill Patients

Area of Science:

• Critical Care Medicine
• Pharmacology
• Thrombosis and Hemostasis

Background:

• Venous thromboembolism (VTE) prophylaxis is crucial in critically ill patients.
• Low body weight patients present unique challenges for standard VTE prophylaxis dosing.
• Optimizing VTE prophylaxis in low body weight patients is essential to balance efficacy and safety.

Purpose of the Study:

• To compare the incidence of bleeding and thromboembolic events between reduced-dose and standard-dose VTE prophylaxis in critically ill, low body weight patients.
• To evaluate the safety and efficacy of adjusted VTE prophylaxis strategies in a specific patient cohort.

Main Methods:

• Multicenter, retrospective cohort study involving five Ascension Health Hospitals.
• Included adult, critically ill patients weighing ≤50 kg who received either reduced-dose (n=140) or standard-dose (n=279) VTE prophylaxis for ≥48 hours.
• Analyzed composite bleeding, major bleeding, clinically relevant nonmajor bleeding, and VTE events.

Main Results:

• Reduced-dose VTE prophylaxis was associated with significantly lower composite bleeding rates (5% vs. 12.5%, P=0.02).
• Adjusted analysis confirmed reduced composite bleeding with reduced-dose prophylaxis (OR: 0.36; 95% CI: 0.14-0.96).
• Rates of VTE events were similar between groups (2.2% vs. 0%, P=0.08), with a trend towards lower major bleeding in the reduced-dose group (3.6% vs. 8.6%, P=0.056).

Conclusions:

• Reduced-dose VTE prophylaxis is associated with a lower risk of bleeding in critically ill, low body weight patients.
• This adjusted dosing strategy appears safe and effective, maintaining similar thromboembolic event rates.
• Findings suggest a potential benefit of individualized VTE prophylaxis in this patient population.