Amanda Neal, PharmD
PGY2 Critical Care Pharmacy Resident
n/a
Savannah, Georgia
Disclosure information not submitted.
Emily Bowers, PharmD
Critical Care Pharmacist
Memorial Health University Medical Center, United States
Disclosure information not submitted.
Eric Shaw, PhD
Professor
Mercer University School of Medicine, United States
Disclosure information not submitted.
Audrey Johnson, PharmD, BCPS, BCCCP
Critical Care Pharmacist
Memorial Health University Medical Center, United States
Disclosure information not submitted.
Title: Obesity-Adjusted Unfractionated Heparin Versus Enoxaparin for Venous Thromboembolism Prophylaxis
Introduction: Hospitalized patients are at an increased risk of venous thromboembolism (VTE) with obesity being an additional substantial risk factor. The risk of VTE is also higher in patients admitted to intensive care units (ICUs) due to risk factors such as sepsis, vasopressor use, mechanical ventilation, and cardiac or renal failure. Unfractionated heparin (UFH) and enoxaparin are both used for VTE prophylaxis in critically ill obese patients. UFH 7,500 units subcutaneous every 8 hours or enoxaparin 0.5 mg/kg/day are suggested regimens in obese patients for VTE prophylaxis. There is limited evidence for a preferred regimen or optimal dose adjustments in obese patients. The objective of this study is to determine the efficacy of VTE prevention between high-dose UFH and weight-adjusted enoxaparin in these patients. To our knowledge, this study will be the first to look at the clinical outcome of VTE incidence when comparing high-dose UFH and weight-adjusted enoxaparin in critically ill obese patients.
Methods: This was a single-center, retrospective, IRB-approved study conducted from July 30, 2015 to January 24, 2021. Adult obese patients who received high-dose UFH (7,500 units every 8 hours) or weight-adjusted enoxaparin (0.5 mg/kg/day) for VTE prophylaxis were eligible for study inclusion. Exclusion criteria included pregnant patients, incarcerated persons, patients with clotting disorders, trauma and orthopedic patients, and CoVID-19 positive patients. The primary outcome was incidence of VTE during hospital stay. Secondary outcomes were hospital length of stay, hospital mortality, and bleeding. Subgroups included admitting ICUs (medical ICU, surgical ICU, or cardiovascular ICU) and patients with a BMI > 50.
Results: A total of 47 patients were included in each group. No significant difference in the incidence of VTE was noted: 2 (4%) patients in the high-dose UFH group versus 1 (2%) in the weight-adjusted enoxaparin group (p=1). There was no significant difference in the length of stay, hospital mortality, and bleeding between groups. The incidence of VTE did not differ between ICU subgroups or in patients with a BMI > 50.
Conclusions: There was not a significant difference in the incidence of VTE between high-dose UFH and weight-adjusted enoxaparin in this obese critically ill population.