PMID- 28097621
OWN - NLM
STAT- MEDLINE
DCOM- 20180427
LR  - 20191210
IS  - 1556-0961 (Electronic)
IS  - 1541-6933 (Linking)
VI  - 27
IP  - 1
DP  - 2017 Aug
TI  - Practice Patterns of Venous Thromboembolism Prophylaxis in Underweight, 
      Critically Ill Patients with Neurologic Injury.
PG  - 96-102
LID - 10.1007/s12028-016-0373-4 [doi]
AB  - PURPOSE: Venous thromboembolism (VTE) prophylaxis in underweight patients with 
      neurologic injury remains unaddressed by guidelines and primary literature. This 
      study aimed to describe VTE prophylaxis strategies employed in this population 
      and compare the impact of underweight and non-obese patients on thrombotic and 
      bleeding events. METHODS: A retrospective review of adults admitted with a 
      diagnosis of neurologic injury to a neurology/neurosurgery intensive care unit 
      (ICU) over 6 years. Patients admitted >/=72 h with an order for VTE prophylaxis 
      during admission, and a body mass index (BMI) <30 kg/m(2) were included. Patients 
      were stratified to underweight (BMI </=18.5 kg/m(2) or weight </=50.0 kg) or 
      non-obese (BMI 18.6-29.9 kg/m(2)) groups and matched, 2:1, on age, diagnosis, and 
      disease severity. RESULTS: The most common regimen in the underweight (n = 107) 
      and non-obese (n = 214) group was unfractionated heparin (UFH) 5000 units 
      subcutaneously Q12 h (69.1 vs. 83.6%; p = 0.003). Only underweight patients 
      received UFH 2500 units subcutaneously Q12 h (17.8 vs. 0.0%; p < 0.0001). The 
      proportion of overall bleeding and thrombotic events while receiving VTE 
      prophylaxis was not significantly different. The proportion of underweight 
      patients developing intracranial hematoma expansion while receiving prophylaxis 
      versus non-obese patients (45.5 vs. 8.3%; p = 0.017) was significant. Patients 
      receiving >150 units/kg/day of UFH displayed a trend toward increased risk of 
      bleeding (9.7 vs. 4.2%; p = 0.064). CONCLUSIONS: Current practice does not 
      reflect dose reductions for neurologically injured, underweight patients. Caution 
      should be considered when using increased doses of UFH in neurologically injured 
      patients that are underweight and/or may be exposed to >150 units/kg/day of UFH. 
      Continued assessment of VTE prophylaxis is needed to confirm these findings.
FAU - Betthauser, Kevin
AU  - Betthauser K
AD  - Department of Pharmacy, Barnes-Jewish Hospital, 216 S. Kingshighway Boulevard, 
      Mailstop 90-52-411, St. Louis, MO, 63110, USA. kxb0665@bjc.org.
AD  - Department of Pharmacy, Barnes-Jewish Hospital, 216 S. Kingshighway Boulevard, 
      St. Louis, MO, 63110, USA. kxb0665@bjc.org.
FAU - Pope, Hannah
AU  - Pope H
AD  - Department of Pharmacy, Barnes-Jewish Hospital, 216 S. Kingshighway Boulevard, 
      Mailstop 90-52-411, St. Louis, MO, 63110, USA.
FAU - Gowan, Mollie
AU  - Gowan M
AD  - Department of Pharmacy, Barnes-Jewish Hospital, 216 S. Kingshighway Boulevard, 
      Mailstop 90-52-411, St. Louis, MO, 63110, USA.
FAU - Human, Theresa
AU  - Human T
AD  - Department of Pharmacy, Barnes-Jewish Hospital, 216 S. Kingshighway Boulevard, 
      Mailstop 90-52-411, St. Louis, MO, 63110, USA.
AD  - Department of Neurology, Washington University, 216 S. Kingshighway Boulevard, 
      St. Louis, MO, 63110, USA.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Neurocrit Care
JT  - Neurocritical care
JID - 101156086
RN  - 0 (Enoxaparin)
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Aged
MH  - *Body Mass Index
MH  - Brain Injuries/*therapy
MH  - Critical Illness
MH  - Enoxaparin/administration & dosage/adverse effects/*pharmacology
MH  - Female
MH  - Fibrinolytic Agents/administration & dosage/adverse effects/*pharmacology
MH  - Heparin/administration & dosage/adverse effects/*pharmacology
MH  - Humans
MH  - Intensive Care Units
MH  - Male
MH  - Middle Aged
MH  - *Outcome Assessment, Health Care
MH  - *Practice Patterns, Physicians'
MH  - Retrospective Studies
MH  - *Thinness
MH  - Venous Thromboembolism/*drug therapy
OTO - NOTNLM
OT  - Acute brain injury
OT  - Heparin
OT  - VTE prophylaxis
EDAT- 2017/01/18 06:00
MHDA- 2018/04/28 06:00
CRDT- 2017/01/19 06:00
PHST- 2017/01/18 06:00 [pubmed]
PHST- 2018/04/28 06:00 [medline]
PHST- 2017/01/19 06:00 [entrez]
AID - 10.1007/s12028-016-0373-4 [pii]
AID - 10.1007/s12028-016-0373-4 [doi]
PST - ppublish
SO  - Neurocrit Care. 2017 Aug;27(1):96-102. doi: 10.1007/s12028-016-0373-4.