Abstract Details

Title Unintentional Therapeutic Anticoagulation in Neurocritically Ill Patients Receiving Pharmacologic Venous Thromboembolism Prophylaxis

Topic Neuro Trauma and Critical Care

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 18-010

Objective Describe the incidence of unintentional therapeutic anticoagulation and associated patient-specific factors in neurocritical care patients receiving pharmacologic venous thromboembolism (VTE) prophylaxis.

Background Neurocritically ill patients have high risk for VTE and central nervous system (CNS) bleeding complications. Optimal pharmacologic VTE prophylaxis regimens remain undetermined.

Design/Methods This retrospective cohort study included adult patients admitted to one neurocritical care unit from January 1, 2023 to December 31, 2024, with peak, steady state anti-factor Xa (aFXa) levels drawn while receiving subcutaneous unfractionated heparin (UFH) or enoxaparin for VTE prophylaxis. Primary outcome was incidence of therapeutic anticoagulation, defined as aFXa >0.3 IU/mL and >0.6 IU/mL for UFH and enoxaparin, respectively. Secondary outcomes included aFXa level, dose adjustments based on aFXa, and factors associated with therapeutic aFXa using univariate and multivariable analyses. Safety outcomes included VTE and CNS bleeding.

Results 155 patients with 203 aFXa levels were included. Mean age, weight, and BMI were 65 years, 83 kg, and 29.1, respectively. 54% were female. Primary diagnoses included intracerebral hemorrhage (26%), acute ischemic stroke (21%), subarachnoid hemorrhage (17%), and traumatic brain injury (14%). 183 UFH and 20 enoxaparin aFXa levels were obtained. Therapeutic anticoagulation occurred in eight patients (5.2%), seven receiving UFH and one enoxaparin. 54% of UFH aFXa were <0.1. Of remaining UFH levels, median aFXa was 0.14 (IQR 0.11-0.19). Median enoxaparin aFXa was 0.24 (IQR 0.19-0.37). 44 dose adjustments occurred utilizing aFXa (21.7%). On univariate analysis, female gender and number of doses before aFXa were associated with therapeutic aFXa, while weight and admission creatinine clearance trended towards significance. Number of doses before aFXa remained significant in the multivariable analysis (OR 1.15, CI 1.03-1.27, p=0.012). VTE occurred in 16 patients (10%) and CNS bleeding in 7 (5%).

Conclusions Unintentional therapeutic anticoagulation can occur with pharmacologic VTE prophylaxis in neurocritically ill patients. Monitoring aFXa might be useful in this population.

Authors/Disclosures
Corinne Bertolaccini, PharmD PRESENTER	Ms. Bertolaccini has nothing to disclose.
Marcey L. Osgood, DO	Dr. Osgood has nothing to disclose.
Anil Ramineni, MD	Dr. Ramineni has nothing to disclose.
Tara K. Lech, PharmD	Dr. Lech has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Perosphere. Dr. Lech has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer. Dr. Lech has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Anticoagulation Forum. Dr. Lech has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Vasculearn Network.
Vahin M. Patel	Mr. Patel has nothing to disclose.
Kathryn Swider (Lahey Hospital and Medical Center)	Dr. Swider has nothing to disclose.
Sara Nuñez, RN	Miss Nuñez has nothing to disclose.
Carla Fernanda Piacentini Dos Santos	Miss Piacentini Dos Santos has nothing to disclose.
Joseph D. Burns, MD (Lahey Hospital and Medical Center)	Dr. Burns has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier.

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