title: Clinical Experience With Pharmacological Venous Thromboembolism Prophylaxis in the Underweight and Critically Ill.
abstract: The optimal regimen for pharmacological prophylaxis of venous thromboembolism (VTE) in underweight, critically ill patients is unknown.
  
  
  
  To describe prescribing patterns for VTE prophylaxis in underweight (≤50 kg or body mass index ≤18.5 kg/m(2)), critically ill patients and identify the prevalence of VTE and bleeding.
  
  
  
  This was a retrospective cohort study that included patients who received standard- or reduced-dose VTE prophylaxis for ≥48 hours.
  
  
  
  A total of 295 individuals were included in the study. The majority of underweight patients in this study (79.7%) received unfractionated heparin, 5000 units 3 times daily. No statistically significant difference in the prevalence of clinically relevant VTEs between the reduced- and standard-dose groups was observed (4.4% vs 5.6%, P = 1.00), but a higher proportion of bleeding events was identified within the standard-dose group (6.7% vs 11.2%, P = 0.4).
  
  
  
  Empirical dose reductions of VTE prophylaxis are infrequently used in underweight, critically ill patients. Further studies need to be conducted that assess the safety and efficacy of reduced-dose VTE prophylactic regimens in this population to determine if acceptable efficacy can be achieved, with lower risks of bleeding.
authors.affiliation: Barnes-Jewish Hospital, St Louis, MO, USA SSM Health St Clare Hospital, Fenton, MO, USA christopher_carter@ssmhc.com.
authors.forename: Christopher
authors.initials: C
authors.lastname: Carter
authors.affiliation: Barnes-Jewish Hospital, St Louis, MO, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bushwitz
authors.affiliation: Barnes-Jewish Hospital, St Louis, MO, USA.
authors.forename: Mollie
authors.initials: M
authors.lastname: Gowan
authors.affiliation: Barnes-Jewish Hospital, St Louis, MO, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Pope
authors.affiliation: Barnes-Jewish Hospital, St Louis, MO, USA.
authors.forename: Theresa
authors.initials: T
authors.lastname: Human
authors.affiliation: Barnes-Jewish Hospital, St Louis, MO, USA.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Gibson
authors.affiliation: Barnes-Jewish Hospital, St Louis, MO, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Owen
authors.affiliation: BJC Healthcare, St Louis, MO, USA.
authors.forename: Nick
authors.initials: N
authors.lastname: Hampton
authors.affiliation: Temple University School of Pharmacy, Philadelphia, PA, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Whitman
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D016638:Critical Illness; D004305:Dose-Response Relationship, Drug; D011307:Drug Prescriptions; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006493:Heparin / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011314:Preventive Health Services / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013851:Thinness; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: anticoagulation; critical care; heparin; low-molecular-weight heparins; prophylaxis