Subcutaneous Heparin Dose in Underweight Critically Ill Patients

Saturday, January 21, 2023

5:00 PM – 5:15 PM PT

Location: George R. Moscone Convention Center, 4

First Author(s)

BL

Bernice Lee, PharmD

Yale New Haven Hospital
New Haven, Connecticut

Disclosure information not submitted.

Co-Author(s)

AA

Abdalla Ammar, PharmD, BCCCP, BCPS,

Clinical Pharmacist Manager, Neurocritical Care
New York Presbyterian Hospital - Weill Cornell Medical College, United States

Disclosure information not submitted.
SS

Sagune Sakya, PharmD, BCPS

Clinical Pharmacist
Yale New Haven Health Hospital, United States

Disclosure information not submitted.
FS

Flint Spitler, PharmD

Clinical Pharmacist
Bridgeport Hospital, United States

Disclosure information not submitted.
LT

Lydia J. Tran, PharmD, BCPS

Senior Clinical Pharmacy Specialist
Yale New Haven Hospital, United States

Disclosure information not submitted.
MA

Mahmoud Ammar, BCCCP, BCPS, FCCM

Critical Care Pharmacist
Yale New Haven Hospital
New Haven, Connecticut

Disclosure information not submitted.

INTRODUCTION: There is limited guidance on the appropriate dosing for pharmacological prophylaxis for venous thromboembolism (VTE) in critically ill underweight patients. This study aims to evaluate safety and efficacy of standard-dose subcutaneous heparin compared to dose-reduced subcutaneous heparin for VTE prophylaxis in critically ill underweight patients.

METHODS : This was a multicenter, retrospective chart review study. Underweight [body mass index (BMI) < 18 kg/m2] adult (≥18 years old) patients were included if they were admitted to the intensive care unit (ICU) for ≥48 hours, on subcutaneous heparin for VTE prophylaxis for >48 hours. Patients were categorized into two cohorts, standard-dose heparin (≥15,000 units/day) cohort and dose-reduced heparin ( < 15,000 units/day) cohort. The primary outcome evaluated was new-onset clinically significant bleed; secondary outcomes were new VTE, ICU and hospital length of stay, and in-hospital mortality.

RESULTS: Of the 255 patients included, 175 (68.63%) patients received standard-dose heparin and 80 (31.37%) patients received dose-reduced heparin. Overall, the baseline demographics were similar between the two groups, however, there were statistically significant differences in gender and baseline tissue plasminogen activator usage. Median heparin dose (standard vs. dose-reduced) was 319.15 [279.59-347.63] vs. 221.73 [202.33-241.69] units/kg/day. Heparin duration was similar between the two groups (8.63 [5.61-13.67] vs. 7.59 [4.40-12.68] days; p=0.17). There was a statistically significant difference in the incidence of clinically significant bleeding between the standard and dose-reduced heparin groups (9.14% vs. 1.25%; p=0.04). There was no difference in the incidence of VTE (2.29% vs. 1.25%; p=0.95), ICU length of stay (5.00 [3.00-9.86] vs. 4.13 [2.94-7.73] days; p=0.10), hospital length of stay (15.06 [8.78-31.32] vs. 14.64 [8.84-21.34] days; p=0.23) or hospital mortality (9.14% vs. 11.25%; p=0.77).

CONCLUSIONS: In this cohort, more bleeds were reported with standard-dose heparin compared to the dose-reduced heparin without an increase in new VTE. Dose-reducing heparin in critically ill underweight patients for VTE prophylaxis should be considered. Larger studies are needed to confirm these findings.