Heparin dosing for venous thromboembolism prophylaxis in obese hospitalized patients: An observational study

Thromb Res. 2018 Sep:169:152-156. doi: 10.1016/j.thromres.2018.07.027. Epub 2018 Jul 29.

Abstract

Objective: To compare rates of VTE occurrence in obese versus non-obese hospitalized patients who received UFH 5000 units subcutaneously q8 h.

Materials and methods: This was a retrospective cohort study conducted in an academic medical center in the United States. Consecutive adult patients who were hospitalized during a 1-year time frame (2015) receiving UFH 5000 units subcutaneously q8 h for VTE prophylaxis. The primary outcome was occurrence of VTE during hospitalization. This was compared between obese (body mass index ≥30 kg/m2) and non-obese (body mass index <30 kg/m2) patients. Secondary outcomes included the occurrence of significant bleeding (i.e. intracranial and gastrointestinal hemorrhage).

Results: There were 5110 patients included in the study cohort, with a mean age of 57 ± 18 years; and 54% (n = 2757) were male. A similar proportion of patients in the obese group (n = 11/1673, 0.7%) and non-obese group (n = 19/3437, 0.6%) developed a VTE (difference 0.1%, 95% CI -0.4 to 0.6%, p = 0.70). The incidence of VTE was also low (n = 1/394, 0.3%) in patients with body mass index ≥40 kg/m2. Intracranial bleeding occurred in 3 (0.2%) patients in the obese group and 2 (0.1%) patients in the non-obese group (difference 0.1%, 95% CI -0.1 to 0.3%, p = 0.34). Gastrointestinal bleeding occurred in 6 (0.4%) patients in the obese group and 13 (0.4%) patients in the non-obese group (difference 0%, 95% CI -0.4 to 0.3%, p > 0.99).

Conclusions: UFH 5000 units subcutaneously q8 h may be sufficient for prevention of VTE in obese patients.

Keywords: Body mass index; Hemorrhage; Heparin; Obesity; Venous thromboembolism.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Anticoagulants / administration & dosage
  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use*
  • Dose-Response Relationship, Drug
  • Female
  • Hemorrhage / chemically induced
  • Heparin / administration & dosage
  • Heparin / adverse effects
  • Heparin / therapeutic use*
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Obesity / complications*
  • Retrospective Studies
  • Treatment Outcome
  • Venous Thromboembolism / complications*
  • Venous Thromboembolism / prevention & control*

Substances

  • Anticoagulants
  • Heparin