title: Bleeding risk secondary to deep vein thrombosis prophylaxis in patients with lower gastrointestinal bleeding.
abstract: BACKGROUND
  Deep vein thrombosis (DVT) and pulmonary embolism (PE) continue to pose a major burden on the health care system in the United States. The precise timing of anticoagulation initiation in critically ill patients with recent or active lower gastrointestinal bleeding (LGIB) is not well defined. We set out to study the safety and efficacy of early heparin administration for DVT prophylaxis in these patients.
  
  
  METHODS
  A review of all patients admitted to the ICU with a diagnosis of LGIB over a 13-year period was performed. A total of 60 patients received subcutaneous heparin along with mechanical prophylaxis, whereas 59 patients had intermittent pneumatic compression devices alone.
  
  
  RESULTS
  There was no difference in morbidity or mortality between the groups who received heparin and the nonheparin cohort. Neither of the groups developed a DVT or PE during the study period. Patients who received heparin had a median ICU LOS of 3 days, when compared with 2 days for patients who did not receive heparin (P < .0118). There was a significant association between units of blood received during the first 24 hours in the ICU and heparin usage (P < .0229). Those administered heparin received more units (median 3) than those who did not receive heparin (median 2).
  
  
  CONCLUSIONS
  Administration of subcutaneous heparin increases the transfusion requirements and LOS in ICU patients with LGIB. After 24 hours, however, the blood transfusion requirements are equivalent. DVT prophylaxis in patients with a diagnosis of LGIB should be initiated after 24 hours of ICU admission.
authors: Department of Surgery and Critical Care, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA. gdeutsch@nshs.edu
authors: Gary B
authors: GB
authors: Deutsch
authors: Anuj R
authors: AR
authors: Kandel
authors: Denis
authors: D
authors: Knobel
authors: Rajeev
authors: R
authors: Gupta
authors: Garry
authors: G
authors: Ritter
authors: Corrado P
authors: CP
authors: Marini
authors: Rafael
authors: R
authors: Barrera
mesh_terms: D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D018570:Risk Assessment; D020246:Venous Thrombosis / Q000150:complications*