Evaluation of Prophylactic Heparin Dosage Strategies and Risk Factors for Venous Thromboembolism in the Critically Ill Patient

Abstract

Background Venous thromboembolism (VTE) occurs frequently in critically ill patients without heparin prophylaxis. Although heparin prevents VTE, VTEs occur frequently despite prophylaxis. A higher heparin dosage may be more effective for preventing VTE. Methods A retrospective study was conducted using the Premier Incorporated Perspective Database to evaluate comparatively the effects of different heparin prophylaxis dosing strategies in the critically ill patient. Critically ill adult patients who were mechanically ventilated for at least 1 day and had an intensive care unit (ICU) length of stay of at least 2 days were included. Patients received 5000 units of heparin either twice/day or 3 times/day. The primary outcome was development of a new VTE. Key secondary outcomes included clinically important bleeding, thrombocytopenia, and mortality. Patients were propensity matched to control for confounding. Multivariable analysis was conducted for VTE risk factors. Results The study included 30,800 patients from 374 hospitals who were propensity matched by heparin dosage. New VTE occurred in 6.16% of patients treated with 3 times/day heparin versus 6.23% with twice/day heparin (p=0.8). No significant differences in the incidence of pulmonary embolism (0.91% vs 0.8%, p=0.29) or deep vein thrombosis (5.56% vs 5.70% p=0.59) were observed between the two types of heparin dosing. No differences were observed between the two types of heparin dosing in in‐hospital mortality (15.8% vs 15.15%), bleeding (0.23% vs 0.33%), or thrombocytopenia (5.19% vs 5.34%, p>0.08 for all), respectively. Risk factors associated with VTE included intraabdominal and urinary tract infections, loop diuretics, malnutrition, obesity, thrombocytopenia, paralytics, vasopressors, female sex, peripheral vascular disease, sepsis, neutropenia, and end‐stage renal disease. Antiplatelet therapy, heart failure, diabetes, and substance abuse were associated with reduced VTE (p<0.05 for all). Conclusions In critically ill patients, prophylactic dosing of heparin 3 times/day versus twice/day was not associated with differences in new VTE or safety outcomes. Several modifiable VTE risk factors were identified.

Global hemostatic status in patients with acute‐on‐chronic liver failure and septics without underlying liver disease

“…Our data on hypercoagulable features in non-liver septics are consistent with clinical observations of an increased risk of both venous and arterial thrombosis in these patients, even in patients receiving optimal pharmacological thromboprophylaxis. [33][34][35][36] In addition, the hypercoagulable features might contribute to microvascular thrombotic events that have been linked to organ failure. 37 The usefulness of anticoagulant therapy to treat the hypercoagulable features of sepsis and sepsis-associated disseminated intravascular coagulation have been debated given the mixed results of clinical studies.…”

Clinical characteristics of acute lower extremity deep venous thrombosis diagnosed by duplex in patients hospitalized for coronavirus disease 2019

“…To spare the necessary patient contact involved, a preference developed for apixaban, which has been used as prophylaxis for patients with cancer, in acute infectious diseases, and in orthopedic thromboprophylaxis with success. [21][22][23] Decision support in our electronic medical record for prophylactic subcutaneous heparin dosing follows Micromedex recommendation, which refers to a study by Reynolds et al 24 that found no difference in every 12 hour and every 8 hour dosing. Our institution practice, however, is to use every 8 hours dosing for patients with a BMI of greater than 30.…”

Perfil de uso de anticoagulantes en pacientes hospitalizados, interacciones farmacológicas y reacciones adversas identificadas

“…Las alteraciones hematológicas representaron la mayor frecuencia de eventos adversos de forma conjunta, y se identificaron casos con presencia de sangrado (equimosis, gingivorragia, epistaxis, hematuria, hematoma, HVDA, HVDB y petequias) en porcentajes diversos. En este sentido, se refiere en la literatura que con HBPM se presenta una tasa de sangrado mínima [55][56][57], así como también para warfarina [58], rivaroxabán [59] y dabigatrán [60]; en el estudio no se presentaron eventos adversos con estos 2 últimos NOAC, pero en los casos positivos la diversidad de tratamientos puede estar relacionada.…”