title: Practice Patterns of Venous Thromboembolism Prophylaxis in Underweight, Critically Ill Patients with Neurologic Injury.
abstract: OBJECTIVE
  Venous thromboembolism (VTE) prophylaxis in underweight patients with neurologic injury remains unaddressed by guidelines and primary literature. This study aimed to describe VTE prophylaxis strategies employed in this population and compare the impact of underweight and non-obese patients on thrombotic and bleeding events.
  
  
  METHODS
  A retrospective review of adults admitted with a diagnosis of neurologic injury to a neurology/neurosurgery intensive care unit (ICU) over 6 years. Patients admitted ≥72 h with an order for VTE prophylaxis during admission, and a body mass index (BMI) <30 kg/m2were included. Patients were stratified to underweight (BMI ≤18.5 kg/m2or weight ≤50.0 kg) or non-obese (BMI 18.6-29.9 kg/m2) groups and matched, 2:1, on age, diagnosis, and disease severity.
  
  
  RESULTS
  The most common regimen in the underweight (n = 107) and non-obese (n = 214) group was unfractionated heparin (UFH) 5000 units subcutaneously Q12 h (69.1 vs. 83.6%; p = 0.003). Only underweight patients received UFH 2500 units subcutaneously Q12 h (17.8 vs. 0.0%; p < 0.0001). The proportion of overall bleeding and thrombotic events while receiving VTE prophylaxis was not significantly different. The proportion of underweight patients developing intracranial hematoma expansion while receiving prophylaxis versus non-obese patients (45.5 vs. 8.3%; p = 0.017) was significant. Patients receiving >150 units/kg/day of UFH displayed a trend toward increased risk of bleeding (9.7 vs. 4.2%; p = 0.064).
  
  
  CONCLUSIONS
  Current practice does not reflect dose reductions for neurologically injured, underweight patients. Caution should be considered when using increased doses of UFH in neurologically injured patients that are underweight and/or may be exposed to >150 units/kg/day of UFH. Continued assessment of VTE prophylaxis is needed to confirm these findings.
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, 216 S. Kingshighway Boulevard, Mailstop 90-52-411, St. Louis, MO, 63110, USA. kxb0665@bjc.org.|Department of Pharmacy, Barnes-Jewish Hospital, 216 S. Kingshighway Boulevard, St. Louis, MO, 63110, USA. kxb0665@bjc.org.
authors.forename: Kevin
authors.initials: K
authors.lastname: Betthauser
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, 216 S. Kingshighway Boulevard, Mailstop 90-52-411, St. Louis, MO, 63110, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Pope
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, 216 S. Kingshighway Boulevard, Mailstop 90-52-411, St. Louis, MO, 63110, USA.
authors.forename: Mollie
authors.initials: M
authors.lastname: Gowan
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, 216 S. Kingshighway Boulevard, Mailstop 90-52-411, St. Louis, MO, 63110, USA.|Department of Neurology, Washington University, 216 S. Kingshighway Boulevard, St. Louis, MO, 63110, USA.
authors.forename: Theresa
authors.initials: T
authors.lastname: Human
mesh_terms: D000368:Aged; D015992:Body Mass Index; D001930:Brain Injuries / Q000628:therapy*; D016638:Critical Illness; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013851:Thinness; D054556:Venous Thromboembolism / Q000188:drug therapy*
chemical_list: D017984:Enoxaparin; D005343:Fibrinolytic Agents; D006493:Heparin
keywords: Acute brain injury; Heparin; VTE prophylaxis