Low Prevalence of Thrombosis Prophylaxis Dose Adjustments Highlights Implications for Patient Safety

Background: Pharmacologic thromboprophylaxis (PTP) is the mainstay prevention strategy for venous thromboembolism (VTE). PTP agents traditionally dosed, like unfractionated heparin (UFH) and enoxaparin (ENOX), are associated with failure and bleeding in obese and underweight patients, respectively....

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Autores principales:	W. Anthony Hawkins, Susan E. Smith, Tia M. Stitt, Aliya Abdulla, Trisha N. Branan, Ronald G. Hall
Formato:	article
Lenguaje:	EN
Publicado:	University of Minnesota Libraries Publishing 2021
Materias:	anthropometry, anticoagulants, primary prevention, obesity, venous thromboembolism Pharmacy and materia medica RS1-441
Acceso en línea:	https://doaj.org/article/26c378424349449b8b31e2593b8cd4d8
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spelling	oai:doaj.org-article:26c378424349449b8b31e2593b8cd4d82021-12-05T18:44:06ZLow Prevalence of Thrombosis Prophylaxis Dose Adjustments Highlights Implications for Patient Safety 10.24926/iip.v12i4.42882155-0417https://doaj.org/article/26c378424349449b8b31e2593b8cd4d82021-10-01T00:00:00Zhttps://pubs.lib.umn.edu/index.php/innovations/article/view/4288https://doaj.org/toc/2155-0417 Background: Pharmacologic thromboprophylaxis (PTP) is the mainstay prevention strategy for venous thromboembolism (VTE). PTP agents traditionally dosed, like unfractionated heparin (UFH) and enoxaparin (ENOX), are associated with failure and bleeding in obese and underweight patients, respectively. Objectives: This study aimed to describe the prevalence of unadjusted ENOX and UFH dosing for PTP based on anthropometric measures. Patients/Methods: This was a post-hoc, multicenter, cross–sectional analysis of critically ill adults receiving PTP with ENOX or UFH. The primary outcome was the prevalence of unadjusted PTP based on body mass index (BMI) and total body weight (TBW). Definitions for dose adjustments were developed based on existing literature. A secondary outcome was to identify factors associated with unadjusted dosing per BMI and TBW using multivariable generalized linear mixed-effect models. Results: The nested cohort included 172 patients (ENOX=46, UFH=126). Unadjusted PTP was observed in 118 patients (68.6%) based on BMI and 74 (43%) per TBW. When comparing UFH to ENOX, more patients who received UFH had doses unadjusted by BMI (78.6% vs. 41.3%, p<0.05) but not TBW (43.7% vs. 41.3%). Factors independently associated with unadjusted PTP per BMI were receipt of UFH (OR 6.93, 95% CI 1.06-8.77) or a BMI underweight or overweight/obese (OR 10.45, 95% CI 4.38-24.92). Having a TBW <50kg or >100kg (OR 4.85, 95% CI 2.15-10.96) were independently associated with unadjusted PTP based on TBW. Conclusions: Unadjusted dosing of PTP occurs frequently in critically ill adults receiving ENOX or UFH. This was seen in body size extremes by both BMI and TBW. W. Anthony HawkinsSusan E. SmithTia M. StittAliya AbdullaTrisha N. BrananRonald G. HallUniversity of Minnesota Libraries Publishingarticleanthropometry, anticoagulants, primary prevention, obesity, venous thromboembolismPharmacy and materia medicaRS1-441ENINNOVATIONS in Pharmacy, Vol 12, Iss 4 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	anthropometry, anticoagulants, primary prevention, obesity, venous thromboembolism Pharmacy and materia medica RS1-441
spellingShingle	anthropometry, anticoagulants, primary prevention, obesity, venous thromboembolism Pharmacy and materia medica RS1-441 W. Anthony Hawkins Susan E. Smith Tia M. Stitt Aliya Abdulla Trisha N. Branan Ronald G. Hall Low Prevalence of Thrombosis Prophylaxis Dose Adjustments Highlights Implications for Patient Safety
description	Background: Pharmacologic thromboprophylaxis (PTP) is the mainstay prevention strategy for venous thromboembolism (VTE). PTP agents traditionally dosed, like unfractionated heparin (UFH) and enoxaparin (ENOX), are associated with failure and bleeding in obese and underweight patients, respectively. Objectives: This study aimed to describe the prevalence of unadjusted ENOX and UFH dosing for PTP based on anthropometric measures. Patients/Methods: This was a post-hoc, multicenter, cross–sectional analysis of critically ill adults receiving PTP with ENOX or UFH. The primary outcome was the prevalence of unadjusted PTP based on body mass index (BMI) and total body weight (TBW). Definitions for dose adjustments were developed based on existing literature. A secondary outcome was to identify factors associated with unadjusted dosing per BMI and TBW using multivariable generalized linear mixed-effect models. Results: The nested cohort included 172 patients (ENOX=46, UFH=126). Unadjusted PTP was observed in 118 patients (68.6%) based on BMI and 74 (43%) per TBW. When comparing UFH to ENOX, more patients who received UFH had doses unadjusted by BMI (78.6% vs. 41.3%, p<0.05) but not TBW (43.7% vs. 41.3%). Factors independently associated with unadjusted PTP per BMI were receipt of UFH (OR 6.93, 95% CI 1.06-8.77) or a BMI underweight or overweight/obese (OR 10.45, 95% CI 4.38-24.92). Having a TBW <50kg or >100kg (OR 4.85, 95% CI 2.15-10.96) were independently associated with unadjusted PTP based on TBW. Conclusions: Unadjusted dosing of PTP occurs frequently in critically ill adults receiving ENOX or UFH. This was seen in body size extremes by both BMI and TBW.
format	article
author	W. Anthony Hawkins Susan E. Smith Tia M. Stitt Aliya Abdulla Trisha N. Branan Ronald G. Hall
author_facet	W. Anthony Hawkins Susan E. Smith Tia M. Stitt Aliya Abdulla Trisha N. Branan Ronald G. Hall
author_sort	W. Anthony Hawkins
title	Low Prevalence of Thrombosis Prophylaxis Dose Adjustments Highlights Implications for Patient Safety
title_short	Low Prevalence of Thrombosis Prophylaxis Dose Adjustments Highlights Implications for Patient Safety
title_full	Low Prevalence of Thrombosis Prophylaxis Dose Adjustments Highlights Implications for Patient Safety
title_fullStr	Low Prevalence of Thrombosis Prophylaxis Dose Adjustments Highlights Implications for Patient Safety
title_full_unstemmed	Low Prevalence of Thrombosis Prophylaxis Dose Adjustments Highlights Implications for Patient Safety
title_sort	low prevalence of thrombosis prophylaxis dose adjustments highlights implications for patient safety
publisher	University of Minnesota Libraries Publishing
publishDate	2021
url	https://doaj.org/article/26c378424349449b8b31e2593b8cd4d8
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Low Prevalence of Thrombosis Prophylaxis Dose Adjustments Highlights Implications for Patient Safety

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