What is it about?
Our study sought to describe venous thromboembolism (VTE) prophylaxis prescribing patterns and the prevalence of associated venous thromboembolisms and bleeding in the underweight and critically ill. This population has been vastly underrepresented in previous registry analyses and clinical trials, even amidst growing knowledge of higher anticoagulant drug exposure in patients receiving non-weight adjusted prophylactic regimens.
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Why is it important?
Our retrospective study with extensive chart review is the first to directly assess VTE prophylaxis strategies and associated adverse events in this population. We report a high use rate of standard dose prophylaxis regimens in this population but a similar prevalence of clinically relevant VTEs as compared to other VTE prophylaxis studies. Additionally, we report one of the highest rates of clinically relevant bleeding to date in a VTE prophylaxis study, which we postulate may be due to a high use rate of standard dose prophylaxis regimens in our study population.
Perspectives
Our study is the first to suggest that there may be an increased bleeding risk with standard dose VTE prophylaxis regimens without improved efficacy in preventing VTEs in an underweight and critically ill population. Thus, I promote the continued study of reduced dose regimens that may decrease the risk of bleeding and maintain efficacy in preventing VTEs in this population. While further study is undertaken, I suggest taking a proactive approach to dose reducing VTE prophylactic regimens (UFH 5000 units BID and Enoxparin 30 mg daily) in patients who meet our study's inclusion criteria (ICU patients > 18 years old, a BMI of < 18.5 kg/m2 or a total body weight of < 50 kg).
Dr. Christopher K Carter
SSM Health
Read the Original
This page is a summary of: Clinical Experience With Pharmacological Venous Thromboembolism Prophylaxis in the Underweight and Critically Ill, Annals of Pharmacotherapy, July 2016, SAGE Publications,
DOI: 10.1177/1060028016657347.
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