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Effectiveness and safety of high-dose unfractionated heparin for venous thromboembolism prophylaxis in obese patients
Friday April 25, 2025 8:30am - 8:45am EDT
Parthenon 2
Title: Effectiveness and safety of high-dose unfractionated heparin for venous thromboembolism prophylaxis in obese patients
Authors: Amber DeVillier, Lacey Ioppolo, Mallory Stringer, Eric Shaw
  1. Background: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a preventable condition causing 60,000 to 100,000 deaths annually in the United States. DVT involves thrombus formation in extremities, while PE occurs when a thrombus blocks a pulmonary artery. Risk factors include Virchow’s triad which consists of venous stasis, endothelial injury, and hypercoagulability. Obesity, an independent VTE risk factor, promotes inflammation, impaired fibrinolysis, and procoagulant activity. The CDC defines obesity as a BMI ≥ 30 kg/m². Hospitalized patients face increased VTE risk due to immobility and surgical endothelial injury. Chemical prophylaxis, such as unfractionated heparin (UFH), low molecular weight heparin (LMWH), or fondaparinux, is essential. Standard dosing of UFH is 5,000 units subcutaneously every 8 hours. In patients with an increased BMI the dosing parameters are not as clear. The dosing for DVT prophylaxis in patients with obesity ranges from 5,000 to 7,500 units subcutaneously every 8 hours. Studies on high-dose UFH of 7,500 mg subcutaneously every 8 hours in obese patients show mixed outcomes, with potential bleeding risks in class III obesity (BMI ≥ 40 kg/m²). Further research is needed to clarify optimal dosing regimens by BMI and assess safety and efficacy.
  2. Methods: This was a single-center, retrospective chart review of patients that were started on either standard-dose UFH of 5,000 mg subcutaneously every 8 hours or high-dose UFH of 7,500 mg subcutaneously every 8 hours for DVT prophylaxis between January 2018 and September 2024. Patients were included if they were 18 years old or older, received either standard-dose or high-dose UFH within 48 hours of admission, and if their BMI was ≥ 40 kg/m² and body weight ≥ 120 kg. The primary outcome was incidence of new VTE during hospital stay. The secondary outcomes included any bleeding that resulted in discontinuation and a composite of ISTH major bleeding.
  3. Results: A total of 352 patients were screened, with 108 patients included in this study. There were 83 patients in the standard-dose UFH group and 25 in the high-dose UFH group. The primary outcome was not statistically different between standard-dose compared to high-dose (2.4% vs 0%; p-value 1.000). The secondary outcome of composite ISTH major bleeding was also not significantly different between standard-dose and high-dose (18.1% vs 32%; p-value 0.252). When looking at individual components of ISTH major bleeding, there were significantly more rates of blood transfusions in the high-dose group compared to the standard-dose group (12% vs 1.2%; p-value 0.038). The secondary outcome of UFH prophylaxis discontinuation due to bleeding occurred in 2 (1.9%) of patients in standard-dose group and none of the patients in the high-dose group.
  4. Conclusions: This study showed that there was no difference in the incidence of new VTE between high-dose and standard-dose UFH, but notably, high-dose UFH was associated with more blood transfusions.
Contact Amber DeVillier (amber.devillier@hcahealthcare.com) with any questions.
Presenters
avatar for Amber Devillier

Amber Devillier

PGY1 Pharmacy Resident, Memorial Health University Medical Center
My name is Amber DeVillier, and I attended University of Louisiana Monroe (ULM) College of Pharmacy. I am currently a PGY1 Pharmacy Resident at Memorial Health University Medical Center in Savannah, GA.
Evaluators
avatar for Jason Dover

Jason Dover

PGY-1 Residency Program Director, Clinical Pharmacist Emergency Medicine/Internal Medicine, East Alabama Medical Center
Friday April 25, 2025 8:30am - 8:45am EDT
Parthenon 2
  Internal Medicine (IM), Memorial Health University Medical Center
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