PMID- 32815544
OWN - NLM
STAT- MEDLINE
DCOM- 20210929
LR  - 20210929
IS  - 1535-2900 (Electronic)
IS  - 1079-2082 (Linking)
VI  - 77
IP  - 19
DP  - 2020 Sep 18
TI  - Prophylactic unfractionated heparin and hemorrhage in neurocritically ill 
      underweight patients: A case series and review of the literature.
PG  - 1571-1577
LID - 10.1093/ajhp/zxaa225 [doi]
AB  - PURPOSE: Three cases of major bleeding associated with thromboprophylactic 
      unfractionated heparin (UFH) therapy in underweight neurocritically ill patients 
      are reported. SUMMARY: Three underweight patients (body mass index of <18.5 
      kg/m2) were treated in the intensive care unit with major bleeds associated with 
      UFH thromboprophylaxis. Two of the patients, a 76-year-old female and a 
      56-year-old female, had hemorrhages on presentation; the third patient, a 
      29-year-old male, developed bleeding during his admission. All 3 patients had 
      past medical histories consisting of acute neurologic conditions within 6 weeks 
      of presentation, including subdural hematoma, subarachnoid hemorrhage, and 
      obstructive hydrocephalus secondary to a brain mass. All hemorrhages developed 
      following the receipt of prophylactic UFH at doses of 5,000 units every 8 to 12 
      hours, which translated to high weight-based dosages (>300 units/kg/d). 
      Additionally, hemorrhages were associated with prolonged activated partial 
      thromboplastin time, which declined following heparin discontinuation. The major 
      bleeds following UFH administration included an acute on chronic subdural 
      hematoma, acute rectus sheath hematoma, and cerebellar hematoma. Stabilization of 
      the subdural hematoma was achieved without the use of protamine and the patient 
      was discharged in stable condition. The other 2 patients expired secondary to 
      their hemorrhagic events. Naranjo nomogram scores for the patients indicated that 
      heparin was the probable cause of bleed in 2 cases and a possible cause in 1 
      case. CONCLUSION: Three major hemorrhages developed following the administration 
      of UFH. Underweight patients with neurologic injury may require increased 
      clinical vigilance, reduced doses, and pharmacodynamic monitoring to improve 
      safety outcomes associated with thromboprophylaxis.
CI  - (c) American Society of Health-System Pharmacists 2020. All rights reserved. For 
      permissions, please e-mail: journals.permissions@oup.com.
FAU - McConachie, Sean M
AU  - McConachie SM
AD  - Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health 
      Sciences, Wayne State University, Detroit, MI.
AD  - Beaumont Hospital, Dearborn, Dearborn, MI.
FAU - Morin, Amy
AU  - Morin A
AD  - Blue Cross Blue Shield of Michigan, Detroit, MI.
FAU - Mouabbi, Karim
AU  - Mouabbi K
AD  - Department of Pharmacy Services, Harper University Hospital, Detroit, MI.
FAU - Soubani, Ayman O
AU  - Soubani AO
AD  - Division of Pulmonary, Critical Care and Sleep Medicine, Detroit Medical Center 
      and School of Medicine, Wayne State University, Detroit, MI.
FAU - Wahby, Krista
AU  - Wahby K
AD  - Department of Pharmacy Services, Harper University Hospital, Detroit, MI.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
PL  - England
TA  - Am J Health Syst Pharm
JT  - American journal of health-system pharmacy : AJHP : official journal of the 
      American Society of Health-System Pharmacists
JID - 9503023
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anticoagulants/adverse effects
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - *Heparin/adverse effects
MH  - Heparin, Low-Molecular-Weight
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Thinness
MH  - *Venous Thromboembolism
OTO - NOTNLM
OT  - critically ill
OT  - hemorrhage
OT  - underweight
OT  - unfractionated heparin
OT  - venous thromboembolism
EDAT- 2020/08/21 06:00
MHDA- 2021/09/30 06:00
CRDT- 2020/08/21 06:00
PHST- 2020/08/21 06:00 [pubmed]
PHST- 2021/09/30 06:00 [medline]
PHST- 2020/08/21 06:00 [entrez]
AID - 5894823 [pii]
AID - 10.1093/ajhp/zxaa225 [doi]
PST - ppublish
SO  - Am J Health Syst Pharm. 2020 Sep 18;77(19):1571-1577. doi: 10.1093/ajhp/zxaa225.