PURPOSE: We sought to study VTE prophylaxis dosage variations among hospitalized patients according to gender.
METHODS: We included all consecutively admitted adult patients between March and July 2009. We excluded patients who had VTE at admission, received therapeutic anticoagulation, had hospital length of stay (HLOS) less than 24 hours or received no pharmacologic prophylaxis throughout the admission. We calculated total doses of unfractionated heparin (UFH) and Low Molecular weight Heparin (LMWH) during the admission. To adjust for HLOS and weight we calculated the dose per 1 kg of body weight and per hospital day.
RESULTS: Out of 215 patients entered in our database, we included 168 patients (47 patients were excluded due to therapeutic anticoagulation). Females comprised 58.3% (98 patients). There were no differences between the two genders in race , body mass index , rates of renal failure , diabetes , heart or lung disease and historical or active malignancy. Males were significantly younger (55 vs. 61; p=0.043). Males had higher utilization of mechanical prophylaxis (51.4% vs. 34.7%, p=0.030) and LMWH (92.9% VS. 81.6% P=0.037). However, adjusted doses of both LMWH and UFH were significantly lower among males compared to females (0.35 mg/kg.day ± 0.23 vs. 0.47 ± 0.24; p= 0.004) (42.7 units/kg.day vs. 97.5; p=0.002). Males had higher incidence of primary composite outcome of VTE, bleeding and death within 120 days (18.6 % vs. 8.2%, p=0.044). There was no difference in hospital or intensive care unit LOS.
CONCLUSION: There is a major variation between genders in VTE prophylaxis dosing regimens. Despite no significant differences in baseline characteristics and co-morbid conditions, men are receiving significantly lower adjusted doses of LMWH and UFH than women. Men are more likely to have worse composite outcome of VTE, bleeding and death than women.
CLINICAL IMPLICATIONS: We suggest that current VTE Prophylaxis dosing may not be adequate for men compared to women. Further studies are much needed to evaluate the value of individualizing the dosing of VTE prophylaxis according to gender.
DISCLOSURE: Ankit Mehra, Consultant fee, speaker bureau, advisory committee, etc. Ousama Dabbagh is on the speaker bureau : SANOFI -AVENTIS; No Product/Research Disclosure Information