title: Evaluating the safety and effectiveness of venous thromboembolism prophylaxis in patients with sickle cell disease.
abstract: Nearly every component of hemostasis is altered in sickle cell disease (SCD), yet little evidence exists to guide utilization of venous thromboembolism prophylaxis (VTEP) in this population. This retrospective cohort study included 135 adult patients admitted with a diagnosis of SCD vaso-occlusive crisis to the general medicine service at a tertiary care academic medical center from August 1, 2011 to August 1, 2013. If VTEP was discontinued, the medical record was reviewed for suspicion of VTE, hemorrhage, heparin-induced thrombocytopenia (HIT), or other adverse events. The primary objective was to characterize the safety and effectiveness of VTEP in SCD. The secondary objective was to assess the correlation of VTE with risk factors documented in the general medical population. Most patients (116/135, 85.9%) were prescribed VTEP upon admission, with early discontinuation in 23 patients (19.8%). Reasons for discontinuation included suspicion of VTE (10/116, 8.6%), hemorrhage (5/116, 4.3%), and/or HIT (4/116, 3.4%). Since patients with SCD receiving standard VTEP regimens appear to have similar outcomes compared to medically ill patients in prospective studies, using these regimens appears to be safe when indicated in the opinion of the provider. Once daily injections may be preferred in order to optimize adherence.
authors.affiliation: Department of Pharmacy, UF Health Jacksonville Medical Center, Jacksonville, FL, 32209, USA.
authors.forename: Denise
authors.identifier: http://orcid.org/0000-0002-2838-7222
authors.initials: D
authors.lastname: Kelley
authors.affiliation: Department of Pharmacy, Ralph H. Johnson VA Medical Center, Charleston, SC, 29425, USA.
authors.forename: Lauren Thornton
authors.initials: LT
authors.lastname: Jones
authors.affiliation: Presbyterian College of Pharmacy, Clinton, SC, 29325, USA.
authors.forename: Jun
authors.initials: J
authors.lastname: Wu
authors.affiliation: Medical Univeristy of South Carolina College of Pharmacy, 280 Calhoun Street QE 205, Charleston, SC, 29425, USA. bohm@musc.edu.
authors.forename: Nicole
authors.initials: N
authors.lastname: Bohm
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D008297:Male; D061214:Patient Safety; D011292:Premedication / Q000009:adverse effects; D012189:Retrospective Studies; D013927:Thrombosis / Q000139:chemically induced; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D006493:Heparin
keywords: Enoxaparin; Heparin; Prophylaxis; Sickle cell disease; Venous thromboembolism