Clinical Experience With Pharmacological Venous Thromboembolism Prophylaxis in the Underweight and Critically Ill

Carter, Christopher; Bushwitz, Jennifer; Gowan, Mollie; Pope, Hannah; Human, Theresa; Gibson, Gabrielle; Owen, Emily; Hampton, Nick; Whitman, Craig

doi:10.1177/1060028016657347

Cited by 11 publications

(27 citation statements)

References 20 publications

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“…prophylaxis, which demonstrated a 10.5% incidence of clinically relevant bleeding. 34 This study did not demonstrate a difference in the primary outcome between enoxaparin dosing regimens, which was contrary to our hypothesis that patients receiving a lower dose of enoxaparin would have fewer major bleeding events (Table 3). This finding may be due to the differences in baseline characteristics between the 2 groups.…”

Section: Discussioncontrasting

confidence: 92%

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Enoxaparin Dosing for Venous Thromboembolism Prophylaxis in Low Body Weight Patients

Dybdahl

Walliser

Pershing

et al. 2019

Clin Med�Insights�Blood�Disord

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Background: The appropriate dose of enoxaparin for venous thromboembolism (VTE) prophylaxis in low body weight patients is unknown. Objective: The aim of this study is to evaluate the impact of enoxaparin dosing on major and minor bleeding events in low body weight patients. Methods: This was a retrospective cohort study of patients weighing less than 45 kg receiving subcutaneous (SC) enoxaparin for VTE prevention. The primary objective was to determine whether enoxaparin dose was associated with major and minor bleeding. The secondary objective was to determine the incidence of VTE by enoxaparin dose. Results: There were 173 patients included in the study, of which 37 patients received 2 different courses of enoxaparin during hospitalization, resulting in 210 enoxaparin courses. Among all enoxaparin courses, 16.2% were associated with major bleeding and 5.2% with minor bleeding. There was no difference in the incidence of major bleeding by dose (enoxaparin 30 mg SC daily, 30 mg SC twice daily, or 40 mg SC daily; P = .409). Patients who experienced major bleeding were older (54.9 ± 16.1 years) than patients who did not (48.4 ± 18.4 years) ( P = .043). There was no difference in the incidence of minor bleeding by dosing schedule ( P = .14). No patients experienced a VTE. Conclusion and Relevance: The risk of bleeding was similar by enoxaparin dose but increased with age in low body weight patients. Given the low incidence of VTE in this study, it is reasonable to consider decreasing the prophylactic enoxaparin dose in low body weight patients, especially in the elderly population.

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Section: Discussioncontrasting

confidence: 92%

“…This is supported by a previous study that included low body weight patients who predominantly received UFH for VTE prophylaxis, which demonstrated a 10.5% incidence of clinically relevant bleeding. 34…”

Section: Discussionmentioning

confidence: 99%

Enoxaparin Dosing for Venous Thromboembolism Prophylaxis in Low Body Weight Patients

Dybdahl

Walliser

Pershing

et al. 2019

Clin Med�Insights�Blood�Disord

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“…7 Whether elevated anti-Xa levels correlate with higher bleeding risk in underweight patients is unknown. [8][9][10] Based on this evidence, some advocate for reducing the prophylactic dose of enoxaparin to 30 mg daily. 11 Practice guidelines and drug manufacturers do not make specific recommendations for dose adjustments in underweight patients.…”

Section: Introductionmentioning

confidence: 99%

“… 7 Whether elevated anti-Xa levels correlate with higher bleeding risk in underweight patients is unknown. 8 – 10 …”

Section: Introductionmentioning

confidence: 99%

Venous Thromboembolism Prophylaxis in Underweight Hospitalized Patients

Buckheit

Lefemine

Sobieraj

et al. 2021

Clin Appl Thromb Hemost

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There is limited evidence about optimal anticoagulant dosing for venous thromboembolism (VTE) prophylaxis in underweight patients. The purpose of this study was to characterize dosing strategies used in underweight patients and compare the incidence of bleeding and VTE to patients receiving a standard dose. This multi-center retrospective study evaluated medicine patients who weighed 45 kilograms or less and received VTE prophylaxis with unfractionated heparin or enoxaparin. We categorized subjects into groups as either standard or reduced dose and compared the incidence of bleeding and VTE between groups. Of the 300 patients included in the outcome analysis, 40.7% received a reduced dose regimen, most often enoxaparin 30 mg daily. Standard dose was associated with major bleeding compared with reduced dose, when adjusted for age, gender and admission hemoglobin (odds ratio 4.73, 95% confidence interval 1.05 to 21.34). Incidence of clinically relevant non-major bleeding (2.4% vs. 1.1%) and VTE (0.6% vs. 0%) were similar between groups. Anticoagulant dose reduction for VTE prophylaxis in underweight hospitalized medicine patients is common practice and associated with less major bleeding.

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“…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…”

mentioning

confidence: 99%

Exploration of an Association Between UFH Dosing Based on Estimated Blood Volume and Venous Thromboembolism and Bleeding in the Underweight and Critically Ill

Carter¹,

Betthauser²,

Peppard³

2020

Ann Pharmacother

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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

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Clinical Experience With Pharmacological Venous Thromboembolism Prophylaxis in the Underweight and Critically Ill

Cited by 11 publications

References 20 publications

Enoxaparin Dosing for Venous Thromboembolism Prophylaxis in Low Body Weight Patients

Enoxaparin Dosing for Venous Thromboembolism Prophylaxis in Low Body Weight Patients

Venous Thromboembolism Prophylaxis in Underweight Hospitalized Patients

Exploration of an Association Between UFH Dosing Based on Estimated Blood Volume and Venous Thromboembolism and Bleeding in the Underweight and Critically Ill

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