Abstract
Purpose: This study aims to evaluate whether current dosing recommendations of UFH for the prevention of thromboembolism is appropriate in obese critically ill patients utilizing Anti-Xa levels. Materials and methods: A pilot, observational and retrospective chart review of critically ill patients was evaluated. Patients aged ≥ 18 years were included if they received subcutaneous UFH for thromboprophylaxis and had a recorded Anti-Xa level taken four to five h after the administration of UFH. Identified patients were categorized into two groups: BMI<30 kg/m2 or BMI ≥ 30 kg/m2. Anti-Xa heparin activity levels were then compared. Statistical analysis was performed using Student’s t-test. Results: A total of 130 adult ICU patients were included in this study. For all critically ill patients receiving 5,000 units of subcutaneous heparin every 8 h, there was no statistically significant difference in Anti-Xa levels between the groups (p=0.287). There was no incidence of DVT/ PE reported from either group. Conclusion: This study suggests that there is no significant difference in Anti- Xa levels between obese critically ill patients and non-obese patients receiving traditional UFH dosing for thromboprophylaxis.
Highlights
Venous thromboembolism (VTE), a spectrum of diseases including deep venous thrombosis (DVT) and pulmonary embolism (PE), frequently affect hospitalized patients and is associated with significant morbidity and mortality [1]
This study suggests that there is no significant difference in AntiXa levels between obese critically ill patients and non-obese patients receiving traditional unfractionated heparin (UFH) dosing for thromboprophylaxis
Ill patients requiring admission into the Medical and Surgical Intensive Care Units (MICU and SICU) have at least one risk factor for VTE that may persist for several weeks after discharge [2,3]
Summary
Venous thromboembolism (VTE), a spectrum of diseases including deep venous thrombosis (DVT) and pulmonary embolism (PE), frequently affect hospitalized patients and is associated with significant morbidity and mortality [1]. Ill patients requiring admission into the Medical and Surgical Intensive Care Units (MICU and SICU) have at least one risk factor for VTE that may persist for several weeks after discharge [2,3]. The incidence of pulmonary embolism (PE) in the United States is estimated to be 1 in 1000 patients per year, accounting for 200,000 to 300,000 hospitalizations annually [4,5]. Studies suggest between 5-10% of all in-hospital deaths occurred due to PE [6,7,8].
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