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Intermittent Subcutaneous Unfractionated Heparin for Venous Thromboembolism Prophylaxis in Pediatric Intensive Care

Autumn M Spyhalsky1, Kelli Jo Welter1, Mackenzie N DeVine1

  • 1Department of Pharmacy, Children's Hospital Colorado, Aurora, Colorado, USA.

Pediatric Blood & Cancer
|July 23, 2026
PubMed

Insights

Subcutaneous unfractionated heparin (sUFH) for venous thromboembolism (VTE) prophylaxis in pediatric intensive care units (PICUs) showed bleeding in 24% and VTE in 11% of patients. Standardized dosing and further research are needed for sUFH safety and effectiveness in pediatric VTE prevention.

Area of Science:

  • Pediatric critical care medicine
  • Pharmacology and therapeutics
  • Hematology and thrombosis

Background:

  • Venous thromboembolism (VTE) is an increasing complication in pediatric intensive care units (PICUs).
  • Intermittent subcutaneous unfractionated heparin (sUFH) is used for VTE prophylaxis in adults but lacks pediatric evidence.
  • sUFH offers benefits in specific pediatric patient populations, including those with renal dysfunction or limited IV access.

Purpose of the Study:

  • To characterize the prophylactic use of sUFH in a pediatric intensive care unit population.
  • To evaluate the incidence of VTE and bleeding events associated with sUFH prophylaxis.
  • To inform the development of standardized dosing strategies for pediatric VTE prophylaxis.

Main Methods:

  • Retrospective cohort study of pediatric patients (≤ 18 years) receiving sUFH for VTE prophylaxis for ≥ 24 hours.
  • Data collection included sUFH dosing, frequency, monitoring, and incidence of bleeding and VTE.
  • Analysis compared outcomes between patients with and without VTE and bleeding events.

Main Results:

  • Sixty-six pediatric patients received sUFH prophylaxis.
  • The median sUFH dose was 89.3 units/kg, with dosing every 8 or 12 hours.
  • VTE occurred in 11% of patients, and bleeding occurred in 24% of patients; no significant dose difference was observed between groups.

Conclusions:

  • Bleeding events (24%) were more frequent than VTE events (11%) in pediatric patients receiving sUFH prophylaxis.
  • Current sUFH dosing strategies may require standardization for improved safety and efficacy in the PICU.
  • Further prospective studies are essential to establish optimal sUFH use for VTE prophylaxis in pediatric intensive care.
Abstract

Keywords:
anticoagulantscritical careheparinpediatricsvenous thromboembolism

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