PURPOSE: Deep vein thrombosis (DVT) and pulmonary embolism (PE) continue to pose a major burden on the hospitalized patients. Currently, there are no established standardized guidelines regarding the administration of DVT prophylaxis in critically ill surgical patients with lower GI bleeding. At our institution every patient admitted to the Surgical Intensive Care Unit (SICU) receives DVT prophylaxis in the form of subcutaneous heparin (SQH).
METHODS: Patients admitted to SICU with a diagnosis of lower GI bleed were evaluated from a prospectively acquired database. Data acquired included: demographic information, hemodynamic, pharmacological, laboratory, type II heparin induced thrombocytopenia, pulmonary embolism, and survival outcomes. All study patients received SQH for DVT prophylaxis dosed according to the risk for thromboembolism.
RESULTS: Prophylactic SQH was administered in 60 patients out of 119 patients. There was a significant association between units of blood received during the first 24 hours in the ICU and heparin (p<0.0229). There was a significant difference in ICU LOS in patients receiving SQH 3 vs 2 days (p<0.0118) / (95% CI: 2 - 3 days) (p<0.0220). Patients in SQH group received more units (median 5, interquartile range 4) than those who did not receive heparin (median 4, IQR: 4).
CONCLUSION: Administration of subcutaneous unfractionated heparin on the first day increases the transfusion requirements and length of stay in patients admitted to the Surgical ICU with a lower GI bleeding. The use of prophylactic anticoagulation for DVT prophylaxis in patients with lower GI bleeding may not be as safe as originally thought and may actually increase the risk of continued bleeding.
CLINICAL IMPLICATIONS: DVT prophylaxis in patients with Lower GI bleeding should be initiated after the first 24 hours of a GI bleed.
DISCLOSURE: Anuj Kandel, No Financial Disclosure Information; No Product/Research Disclosure Information