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Evaluation Of Prophylactic Heparin Dosage Strategies And Risk Factors For Venous Thromboembolism In The Critically Ill Patient

P. Reynolds, E. V. Van Matre, G. Wright, R. McQueen, E. Burnham, P. Ho, M. Moss, R. Vandivier, T. Kiser
Published 2019 · Medicine

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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.
This paper references
Antihypertensive drugs and fibrinolytic function.
Roberto Fogari (2006)
10.1378/chest.15-0287
VTE Incidence and Risk Factors in Patients With Severe Sepsis and Septic Shock.
David A Kaplan (2015)
10.1097/01.CCM.0000171207.95319.B2
Deep venous thrombosis in medical-surgical critically ill patients: Prevalence, incidence, and risk factors
D. Cook (2005)
10.1053/JCRC.2002.33941
Venous thromboembolism and its prevention in critical care.
W. Geerts (2002)
10.1097/CCM.0000000000003288
Half-Dose Versus Full-Dose Alteplase for Treatment of Pulmonary Embolism*
T. Kiser (2018)
10.1164/rccm.201401-0058OC
Outcomes associated with corticosteroid dosage in critically ill patients with acute exacerbations of chronic obstructive pulmonary disease.
T. Kiser (2014)
10.1378/chest.11-2404
Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
Y. Falck-Ytter (2012)
10.1016/j.jcrc.2005.09.006
Research agenda: venous thromboembolism in medical-surgical critically ill patients.
Deborah J Cook (2005)
10.1097/CCM.0000000000002763
Outcomes of ICU Patients With a Discharge Diagnosis of Critical Illness Polyneuromyopathy: A Propensity-Matched Analysis
Daniel A Kelmenson (2017)
10.1016/0883-9441(89)90128-7
The Swan-Ganz Catheter: A decade of hemodynamic monitoring
C. Putterman (1989)
Anti-Factor Xa Activity of Prophylactic Enoxaparin Regimens in Critically Ill Patients.
Y. Helviz (2016)
Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial
J. O'Brien (2000)
10.3346/jkms.2016.31.11.1828
Pharmacological and Mechanical Thromboprophylaxis in Critically Ill Patients: a Network Meta-Analysis of 12 Trials
J. Park (2016)
10.1055/s-0034-1398386
Venous thromboembolism prophylaxis in critically ill patients.
K. Boonyawat (2015)
10.1053/JCRC.2000.19224
Venous thromboembolic disease: an observational study in medical-surgical intensive care unit patients.
D. Cook (2000)
10.1160/TH13-01-0042
Efficacy and safety of high-dose thromboprophylaxis in morbidly obese inpatients.
T. Wang (2014)
10.1164/rccm.201706-1132OC
An Observational Study of the Efficacy of Cisatracurium Compared with Vecuronium in Patients with or at Risk for Acute Respiratory Distress Syndrome
P. Sottile (2018)
10.1378/chest.11-1444
Omission of early thromboprophylaxis and mortality in critically ill patients: a multicenter registry study.
K. Ho (2011)
10.1186/cc4952
Anti-Xa activity after subcutaneous administration of dalteparin in ICU patients with and without subcutaneous oedema: a pilot study
M. Rommers (2006)
10.1111/jth.13140
Definition of clinically relevant non‐major bleeding in studies of anticoagulants in atrial fibrillation and venous thromboembolic disease in non‐surgical patients: communication from the SSC of the ISTH
S. Kaatz (2015)
10.1378/CHEST.06-1861
Twice vs three times daily heparin dosing for thromboembolism prophylaxis in the general medical population: A metaanalysis.
C. King (2007)
The diagnostic and therapeutic approach to acute bronchiolitis in hospitalized children in Israel: a nationwide survey.
I. Offer (2000)
10.1001/jamainternmed.2013.14673
Histamine-2 receptor antagonists vs proton pump inhibitors on gastrointestinal tract hemorrhage and infectious complications in the intensive care unit.
R. MacLaren (2014)
Physicians Evidence-Based Clinical Practice Development : American College of Chest Thrombolytic Therapy Guideline Methodology for Antithrombotic and
H. Schünemann (2008)
10.1002/14651858.CD005258.pub2
Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high-risk patients.
S. Kakkos (2008)
10.1378/chest.10-3084
Dosing frequency of unfractionated heparin thromboprophylaxis: a meta-analysis.
O. Phung (2011)
10.1378/chest.11-2296
Prevention of VTE in nonsurgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
S. Kahn (2012)
10.1097/CCM.0000000000000713
Failure of Anticoagulant Thromboprophylaxis: Risk Factors in Medical-Surgical Critically Ill Patients*
W. Lim (2015)
10.1007/s11739-010-0359-8
Venous thromboembolism prophylaxis with unfractionated heparin in the hospitalized medical patient: the case for thrice daily over twice daily dosing
Charles E. Mahan (2010)
10.1016/J.JCRC.2005.09.056
Monitoring of subcutaneous dalteparin in patients with renal insufficiency under intensive care: an observational study.
C. Kani (2006)
10.1177/000313481508100923
Standard Dosing of Enoxaparin for Venous Thromboembolism Prophylaxis is Not Sufficient for Most Patients within a Trauma Intensive Care Unit
Jack W. Rostas (2015)
10.1378/CHEST.06-2993
Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the International Medical Prevention Registry on Venous Thromboembolism.
V. F. Tapson (2007)
10.1007/s00134-011-2453-4
Standard subcutaneous dosing of unfractionated heparin for venous thromboembolism prophylaxis in surgical ICU patients leads to subtherapeutic factor Xa inhibition
Sara S. Cheng (2011)
10.1097/01.CCM.0000059725.60509.A0
Prophylactic anticoagulation with enoxaparin: Is the subcutaneous route appropriate in the critically ill?*
U. Priglinger (2003)
comes associated with corticosteroid dosage in critically ill patients with acute exacerbations of chronic obstructive pulmonary disease
TH Kiser (2014)
10.1007/s10620-011-1582-5
Deep Vein Thrombosis and Pulmonary Embolism in Hospitalized Patients with Cirrhosis: A Nationwide Analysis
M. Ali (2011)
10.1378/chest.11-2297
Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
M. Gould (2012)
10.1056/NEJMoa1014475
Dalteparin versus unfractionated heparin in critically ill patients.
D. Cook (2011)
10.1055/S-0037-1617143
The coagulant response in sepsis and inflammation.
M. Levi (2010)
10.1016/J.AMJHYPER.2006.04.013
Antihypertensive Drugs and Fibrinolytic Function: Impact of Dual Calcium Channel and Renin-Angiotensin System Blockade
Roberto Fogari (2006)



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