Prophylactic low-molecular-weight heparin: prescription practice in an intensive care unit.
OBJECTIVE
The aim of this study was to review the use of low-molecular-weight heparin (LMWH) in a medical intensive care unit.


METHODS
Double-blind prospective study conducted in a 14-bed intensive care unit, covering all patients admitted over a 2-month period. A comparison with 2 guidelines based on indication, age of the patient, kidney function, platelet count, and duration of treatment was performed. Bleeding complication and clinically diagnosed phlebitis episodes were collected.


RESULTS
One hundred thirty-six patients (71 treated with LMWH and 65 untreated) were included in the study (mean age, 60 +/- 18 years; SAPS (Simplified Acute Physiology Score) II, 39 +/- 23). Among treated patients, 9 were overtreated (13%), and among nontreated patients, 13 were undertreated (20%). In the cohort of treated patients, reasons for failure to comply with recommendations included age of the patient (30%), creatinine clearance (18%), platelet count (32.4%), and duration of treatment (12.7%). Low-molecular-weight heparin prescriptions were conforming to the 4 criteria in 35.2% of patients, to 3 in 43.7%, to 2 in 19.7%, and to 1 in 1.4%.


CONCLUSIONS
The prescription of prophylactic LMWH in intensive care has become a routine. Our study shows that over- and underprescription are common together with misuse.
Tilleul
Patrick
P
APHP Pharmacie, Hôpital Saint Antoine, 75571 Paris cx 12, France.
Tredan
Gaëlle
G
Austruy
Géraldine
G
Maury
Eric
E
Offenstadt
Georges
G
Guidet
Bertrand
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D003404:Creatinine / Q000378:metabolism; D017985:Dalteparin / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010976:Platelet Count; D011446:Prospective Studies
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D003404:Creatinine; D017985:Dalteparin