We undertook a post hoc analysis of study data published in the journal to further investigate the association between bleeding risk and the use of venous thromboembolism (VTE) prophylaxis in underweight, critically ill patients and to optimize its dosing. 1 Given the low volume of distribution and 1-compartment model of unfractionated heparin (UFH), dosing based on estimated blood volume (EBV) could be used to improve safety and efficacy. Clinical utility has been suggested with this strategy in a previous study assessing therapeutic anticoagulation with UFH. 2 We sought to describe the relationship between EBV, daily UFH dose, and the incidence of VTE and bleeding in underweight (≤50 kg or BMI ≤18.5 kg/m 2), critically ill patients. We performed a post hoc analysis of a retrospective cohort study that included adult intensive care unit patients who received standard-or reduced-dose VTE prophylaxis at a large academic medical center from September 2009 to March 2014. EBV was calculated using Nadler's formula. 3 Patients were stratified into lowdose UFH (<3.5 U/mL/d) and high-dose UFH (≥3.5 U/ mL/d) groups. This cutoff was derived from mean population kinetic data suggesting that a typical patient (EBV of 4.3 L) who receives UFH 5000 units subcutaneously every 8 hours would be exposed to ~3.5 U/mL/d. 4 The primary end point assessed was the prevalence of clinically relevant bleeding and VTE in each group. A total of 255 patients were included in the analysis; 84 patients were included in the low-dose group, and 171

Background: Point-of-care (POC) glucometers are commonly used in intensive care units (ICUs). The Centers for Medicare & Medicaid Services have called into question the accuracy of POC glucometers in critically ill patients. This study sought to identify specific characteristics within our facility’s ICU patients that were associated with inaccuracies in POC glucose measurements. Methods: We conducted a prospective cohort study that compared POC capillary blood glucose samples with venous samples collected in our ICU. All nonpregnant patients >18 years old admitted to the ICU with orders for daily laboratory testing that included blood glucose were eligible for inclusion. Results: A total of 46 patients were enrolled and 85 samples were collected. The mean difference between venous and POC samples was 5.23 mg/dL (95% CI, 3.16-7.3 mg/dL). Measurement inaccuracies would have altered treatment in 7/85 instances (8.2%). The only clinically significant inaccuracy found was the omission of 2 units of insulin in 1 hyperglycemic patient. Measurement inconsistencies generally underestimated low blood glucose values (2/2 instances) and overestimated high blood glucose values (4/5 instances). Conclusions: In our study, the mean difference between venous and POC glucose samples was small. Similarly, measurement inaccuracies that would have altered treatment were rare and only one instance was deemed clinically significant. We conclude that POC capillary glucose testing within our cohort and in similar critically ill patients is likely safe and effective.

Background: The optimal dosing for enoxaparin venous thromboembolism (VTE) prophylaxis in low-weight trauma patients is unknown. Estimated blood volume (EBV) has shown promise as a dose modifier. Objective: To characterize the association of enoxaparin dose per EBV with the prevalence of VTE and bleeding in low-weight trauma patients. Methods: This was a retrospective study of trauma patients admitted over a 4-year period. Included patients were adults weighing <60 kg who received a minimum of 3 consecutive doses of enoxaparin. The primary endpoint was a comparison of enoxaparin dose per EBV in patients experiencing bleeding and VTE. Secondary endpoints included comparisons of dose per body mass index (BMI) and total body weight (TBW) and the ability of dose per EBV to predict clinical endpoints. Subgroup analyses for patients weighing <50 kg were performed for all endpoints. Results: A total of 189 patients were included. Statistical comparisons for VTE were not performed because of low prevalence. The dose of enoxaparin per EBV was not statistically different between patients who did and did not bleed in all analyses. Doses per BMI and TBW were also not statistically different between the groups. In patients weighing <50 kg, numerically higher doses per EBV, BMI, and TBW were noted in patients that bled versus those that did not. Enoxaparin dose per EBV was not a statistically significant predictor of bleeding in logistic regression models. Conclusion and Relevance: No significant associations between enoxaparin dose per EBV, BMI, or TBW and bleeding were noted in the study. Future analyses of EBV and other dose modifiers should consider inclusion of patients weighing <50 kg.