Retrospective Study of Venous Thromboembolism Prophylaxis Dosing of Heparin in Adult Patients receiving Continuous Renal Replacement Therapy

Background: Appropriate chemical and/or mechanical venous thromboembolism prophylaxis is a high priority for clinicians. Unfortunately, there is little evidence-based guidance for clinical decision making for patients requiring both renal replacement therapy and VTE prophylaxis. The package insert for unfractionated heparin recommends 5000 units subcutaneously every 8 to 12 hours for VTE prophylaxis. Objective: The purpose of this study was to assess the two recommended dosing intervals and determine if there is a difference in terms of incidence of clotting or bleeding events. Methods: 159 patients were admitted to the UNC Health Care system between March 2014 and November 2019 and retrospectively screened for incidence of both the primary composite efficacy outcome (symptomatic or asymptomatic vascular event (VTE [DVT and PE]), ischemic event (stroke, TIA, or myocardial infarction), or death related to coagulopathy), the individual components of the composite outcome and the primary safety outcome. The results of the outcomes were then compared and analyzed using Fischer’s Exact test. Results: The two tailed p-values of the primary composite efficacy outcome (0.3517), the primary safety outcome (0.1571) and each of the composite outcomes (0.1556, 1.0000, 0.2297, respectively) showed no statistically significant difference. Conclusion: Results of this study show that there is no statistical difference between the dosing intervals of prophylactic UFH of every 8 to 12 hours, in terms of the incidence of VTE and major bleed events, for patients requiring CRRT. Suggesting that either interval is both efficacious and safe for the use of VTE prophylaxis.

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Single Center Experience with Venous Thromboembolism Prophylaxis for Obese Burn Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/irab039 ◽

2021 ◽

Author(s):

Brian P McKinzie ◽

Rabia Nizamani ◽

Samuel Jones ◽

Booker King ◽

Felicia N Williams

Keyword(s):

Venous Thromboembolism ◽

Peak Plasma ◽

Retrospective Chart Review ◽

Burn Patients ◽

Thromboembolism Prophylaxis ◽

Vte Prophylaxis ◽

Venous Thromboembolism Prophylaxis ◽

Single Center Experience ◽

Current Utilization ◽

Injured Patients

Abstract Burn injured patients are at high risk of thromboembolic complications. Morbid obesity further increases this risk. Our objective was to evaluate the efficacy of enoxaparin dosed 40mg twice daily in achieving prophylactic plasma anti-Xa levels in obese burn patients. A retrospective chart review from November 2018 until September 2019 identified patients who were either ≥100 kilograms (kg) or had a body mass index ≥ 30 kg/m 2 and initiated on enoxaparin 40 mg twice daily for venous thromboembolism prophylaxis. Patients were ≥ 18 years of age and received ≥ three sequential doses of enoxaparin with appropriately timed peak plasma anti-Xa levels to monitor efficacy. One hundred forty-eight patients were screened with 43 patients included for analysis. Forty-two percent of the patients did not reach target peak plasma anti-Xa levels (0.2-0.5 IU/mL) on enoxaparin 40 mg twice daily. Patients who did not meet prophylactic target levels were more likely to be male (p<0.05) and have an increased mean body weight (129 +/- 24 kg versus 110 +/- 16 kg, p<0.05). Thirteen out of 18 patients received dosage adjustments with subsequent anti-Xa levels available for follow-up assessment, of which an additional six patients required further dosage adjustment to meet prophylactic goals. Current utilization of a fixed 40 mg twice daily regimen of enoxaparin for VTE prophylaxis is inadequate to meet target prophylactic peak plasma anti-Xa levels in the obese burn patient population. Dose adjusting enoxaparin to target anti-Xa levels to reduce VTE rates in obese burn patients should be further evaluated.

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Rivaroxaban for the prevention of venous thromboembolism after radiofrequency ablation of saphenous veins concomitant with miniphlebectomy, sclerotherapy, or no treatment of varicose tributaries

Phlebology The Journal of Venous Disease ◽

10.1177/02683555211017336 ◽

2021 ◽

pp. 026835552110173

Author(s):

Elena Murzina ◽

Kirill Lobastov ◽

Leonid Laberko ◽

Anton Dvornikov ◽

Ivan Popov

Keyword(s):

Venous Thromboembolism ◽

Radiofrequency Ablation ◽

Thromboembolism Prophylaxis ◽

Once Daily ◽

Vte Prophylaxis ◽

Vein Thrombosis ◽

Saphenous Veins ◽

Symptomatic Pulmonary Embolism ◽

Efficacy Outcome ◽

Deep Vein

Objective To assess the efficacy and safety of once-daily 10 mg rivaroxaban for venous thromboembolism prophylaxis after ClosureFast radiofrequency ablation (RFA) of saphenous veins. Method The medical records of patients, who had a Caprini score of ≥3, underwent RFA, received prophylactic rivaroxaban for five days, and completed follow up at one month were reviewed for efficacy (a combination of endovenous heat-induced thrombosis [EHIT] grade of 2–4, any symptomatic or asymptomatic deep vein thrombosis [DVT], and symptomatic pulmonary embolism [PE]) and safety (a combination of major and clinically relevant non-major [CRNM] bleeding) outcomes. Results The results of RFA for 248 great saphenous and 24 small saphenous veins with the concomitant miniphlebectomy (63.8%) and sclerotherapy (16.5%) were analyzed. The primary efficacy outcome occurred in 5 of 218 (2.3%; 95%CI, 1.0–5.3%) patients: three EHITs and two symptomatic DVTs. The CRNM bleeding was reported in two patients (0.9%; 95% CI, 0.2–3.3%). No difference was observed in comparison with 79 similar patients who received 40 mg of subcutaneous enoxaparin during the same time period. Conclusion Once-daily 10 mg rivaroxaban is suitable for VTE prophylaxis after RFA of saphenous veins.

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Multi-screen electronic alerts to augment venous thromboembolism prophylaxis

Thrombosis and Haemostasis ◽

10.1160/th09-09-0634 ◽

2010 ◽

Vol 103 (02) ◽

pp. 312-317 ◽

Cited By ~ 32

Author(s):

Karen Fiumara ◽

Chiara Piovella ◽

Shelley Hurwitz ◽

Gregory Piazza ◽

Clyde Niles ◽

...

Keyword(s):

Venous Thromboembolism ◽

High Risk ◽

Thromboembolism Prophylaxis ◽

Vte Prophylaxis ◽

Hospitalised Patients ◽

Electronic Alerts ◽

Significant Difference ◽

Alert Program ◽

Risk Patients ◽

The One

SummaryVenous thromboembolism (VTE) prophylaxis in high-risk patients is frequently underutilised. We previously devised a one-screen computer alert program that identified hospitalised patients at high risk for VTE who were not receiving prophylaxis and advised their physicians to prescribe prophylaxis. While this strategy reduced the 90-day incidence of symptomatic VTE by 41%, the majority of electronic alerts were ignored. We have now developed a serial three-screen alert computer program designed to educate physicians who initially declined to order prophylaxis after a single screen alert. Of a total cohort of 880, the responsible physicians for 425 patients received a single electronic alert, whereas 455 who declined prophylaxis after the first screen received the second and third screens of the novel three-screen alert. Our enhanced serial three-screen alert program generated VTE prophylaxis orders for 58.4% of the 455 patients whose physicians initially declined to order prophylaxis following the one-screen alert. There was no significant difference in symptomatic 90-day VTE rates between the two cohorts (2.8% for the one-screen vs. 2.2% for the three-screen, p=0.55). We conclude that our three-screen computer alert program can markedly increase prophylaxis among physicians who decline an initial single screen alert.

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Assessment of the Use of Pharmacologic Venous Thromboembolism Prophylaxis in Post-Traumatic Brain Injury Patients

Journal of Pharmacy Practice ◽

10.1177/0897190020929811 ◽

2020 ◽

pp. 089719002092981

Author(s):

Raghad Saadi ◽

Kimberly Brandt ◽

Robert Madlinger ◽

Steven F. Nerenberg

Keyword(s):

Traumatic Brain Injury ◽

Venous Thromboembolism ◽

Brain Injury ◽

Bleeding Complications ◽

Optimal Timing ◽

Linear Regression Models ◽

Thromboembolism Prophylaxis ◽

Vte Prophylaxis ◽

Scan Time ◽

Significant Difference

Background: Traumatic brain injury (TBI) is an independent risk factor for venous thromboembolism (VTE). Prophylaxis (PPX) beyond 48 hours increases VTE risk 3- to 4-fold. Pharmacologic VTE PPX initiation is controversial due to potential bleeding complications. Objective: To evaluate VTE PPX in patients with TBI for practice variation, efficacy, and safety. Methods: Retrospective review from January 2013 to September 2016 in adults admitted to the intensive care unit with moderate to severe TBI. Demographics, time to stable computerized tomography scan, time to PPX initiation, PPX regimen, and incidences of VTE and adverse effects were collected. Data were analyzed via descriptive statistics, analysis of variance, and linear regression models. Results: Of 96 patients included, 14.6% did not receive VTE PPX (G1), 7.3% initiated therapy within 0 to 24 hours (G2), 14.6% after 24 to 48 hours (G3), and 63.5% after 48 hours (G4). VTE occurred in 0% of G1 and G2, 28.6% of G3, and 8.2% of G4 patients ( P = .038). Of 9 VTE cases, 8 received medical and 1 received trauma PPX dosing ( P = .44). There were 3 major bleeds ( P = .79) and 19 minor bleeds ( P = .042). Of 14 fatalities, 42.9% were in G1, 0% in G2, 14.2% in G3, and 42.9% in G4 ( P = .009). Conclusion: The majority of patients received delayed PPX, with no correlation between VTE incidence and PPX regimen. There was a significant difference in VTE incidence stratified by time to PPX. Further studies are required to determine optimal timing of PPX. Higher mortality rate was correlated with the lack of PPX. Increased minor bleeds occurred with earlier PPX initiation.

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Comparison of the effectiveness of venous thromboembolism prophylaxis with enoxaparin between obese and non-obese patients

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155218760159 ◽

2018 ◽

Vol 25 (4) ◽

pp. 813-817 ◽

Cited By ~ 3

Author(s):

Abdelmajid H Alnatsheh ◽

Robert D Beckett ◽

Stacy Waterman

Keyword(s):

Body Mass Index ◽

Venous Thromboembolism ◽

Body Mass ◽

Hospitalized Patients ◽

Obese Group ◽

Obese Patients ◽

Thromboembolism Prophylaxis ◽

Venous Thromboembolism Prophylaxis ◽

Significant Difference ◽

Group 2

Objective The purpose of this study is to compare the incidence of venous thromboembolism between obese and non-obese hospitalized patients who received United States Food and Drug Administration-approved prophylactic enoxaparin doses and to describe enoxaparin dosing strategies used in obese patients. Methods This was a retrospective cohort study including patients who were admitted to Parkview Regional Medical Center, Parkview Hospital, or Parkview Orthopedic Hospital between September 2011 and August 2012 and received at least one dose of enoxaparin 30 mg twice daily or enoxaparin 40 mg once daily for venous thromboembolism prophylaxis. Patients classified based on their body mass index into three groups, Group 1 (non-obese: body mass index < 25 kg/m2), Group 2 (overweight: body mass index ≥ 25 kg/m2 but < 30 kg/m2), and Group 3 (obese: body mass index ≥ 30 kg/m2). The primary endpoint was venous thromboembolism occurrence within 90 days, considering day 1 of hospitalization as day 1. Results Of the 428 patients included, 8 cases of venous thromboembolism (1.9%) were identified; 3 in the non-obese group, 2 in the overweight group, and 3 in the obese group, no statistically significant differences were found between the three groups, p = 0.81. When venous thromboembolism incidence was adjusted for age and sex, no statistically significant differences were found between overweight (OR = 0.685; 95% CI 0.115–4.095), obese (OR = 0.797; 95% CI 0.353–1.796), and combined overweight and obese (OR = 0.656; 95% CI 0.154–2.799) groups compared to patients with normal body weight. Conclusion This study did not find a statistically significant difference in venous thromboembolism incidence between obese, overweight, and non-obese hospitalized patients receiving approved enoxaparin prophylaxis doses.

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