Key result
Standard dose VTE prophylaxis was associated with a significantly higher risk of major bleeding compared to reduced dose in hospitalized patients weighing ≤45 kg (OR 4.73; 95% CI 1.05-21.34).
Why the study?
There is limited evidence about optimal anticoagulant dosing for venous thromboembolism (VTE) prophylaxis in underweight patients.
Does reduced dose VTE prophylaxis reduce bleeding compared to standard dose in hospitalized patients weighing 45 kg or less?
Cohort (n=300)
Yes
Does reduced dose VTE prophylaxis reduce bleeding compared to standard dose in hospitalized patients weighing 45 kg or less?
Odds Ratio: 4.73 (95% CI 1.05–21.34)
In underweight hospitalized patients (≤45 kg), reduced dose VTE prophylaxis is associated with significantly less major bleeding than standard dosing, with similar VTE rates.
VTE prophylaxis dosing in underweight patients should not yet change practice; leaves open optimal strategies pending prospective trials.
There is limited evidence about optimal anticoagulant dosing for venous thromboembolism (VTE) prophylaxis in underweight patients. The purpose of this study was to characterize dosing strategies used in underweight patients and compare the incidence of bleeding and VTE to patients receiving a standard dose. This multi-center retrospective study evaluated medicine patients who weighed 45 kilograms or less and received VTE prophylaxis with unfractionated heparin or enoxaparin. We categorized subjects into groups as either standard or reduced dose and compared the incidence of bleeding and VTE between groups. Of the 300 patients included in the outcome analysis, 40.7% received a reduced dose regimen, most often enoxaparin 30 mg daily. Standard dose was associated with major bleeding compared with reduced dose, when adjusted for age, gender and admission hemoglobin (odds ratio 4.73, 95% confidence interval 1.05 to 21.34). Incidence of clinically relevant non-major bleeding (2.4% vs. 1.1%) and VTE (0.6% vs. 0%) were similar between groups. Anticoagulant dose reduction for VTE prophylaxis in underweight hospitalized medicine patients is common practice and associated with less major bleeding.
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Buckheit et al. (2021) conducted a cohort in Venous thromboembolism prophylaxis in underweight patients (n=300). Standard dose VTE prophylaxis vs. Reduced dose VTE prophylaxis was evaluated on Major bleeding (OR 4.73, 95% CI 1.05 to 21.34). Standard dose VTE prophylaxis was associated with a significantly higher risk of major bleeding compared to reduced dose in hospitalized patients weighing ≤45 kg (OR 4.73; 95% CI 1.05-21.34).
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