Original Research
Sunday, November 12, 2023
12:45 PM–02:15 PM
Abstract
Introduction: Standardized dosing of venous thromboembolism (VTE) prophylaxis has been shown to be suboptimal in critically ill patients. A pharmacist-led protocol was implemented to select and optimize VTE prophylaxis in this population.
Research Question or Hypothesis: Does VTE prophylaxis dosed via a pharmacist-driven protocol confer a similar bleed risk compared with standard VTE prophylaxis?
Study Design: Retrospective cohort study utilizing data from an electronic medical record between the dates of January 1st 2022 to November 11th 2022 (protocolized group) and January 1st 2019 through November 11th 2019 (standard group).
Methods: Patients were included if they were admitted to the medical intensive care unit (MICU) and received VTE prophylaxis via the pharmacist driven-protocol or standard VTE prophylaxis. The protocol selected and adjusted doses based on patient renal function and body mass index (BMI). The primary outcome compared frequency of bleeding events, as defined by the International Society of Thrombosis and Hemostasis. Secondary outcomes included frequency of VTE events, hospital and ICU length of stay, and in-hospital mortality. Data were analyzed using Fisher’s-exact or Chi-square and Mann Whitney-U tests as appropriate and alpha was set at 0.05.
Results: Overall, 147 patients were included; 87 in the protocolized group and 60 in the standard group. Patients were approximately 60 years old, and there were more females in the standard (32 (53.3%)) versus the protocolized group (32 (36.8%), p=0.05). Patients had a median BMI of approximately 29 kg/m2 and a median serum creatinine of approximately 1.0 mg/dL. VTE and bleed related risk factors were similar. Frequency of bleeding and VTE events did not differ between the protocolized versus standard group (4.6% vs. 3.3%, p=1.00 and 2.3% vs. 3.3%, p=1.00; respectively). ICU and hospital length of stay and hospital mortality did not differ between the groups.
Conclusion: A pharmacist-driven VTE prophylaxis protocol appears to be safe in terms of bleeding risk in most critically-ill patients.
Presenting Author
Alexis Watters PharmDKaleida Health/Buffalo General Medical Center
Authors
Brian Kersten PharmD, BCPS, BCCCP
Buffalo General Medical Center
Patrick McGrath PharmD
Kaleida Health: Buffalo General Hospital
Maya Chilbert Pharm.D., BCCP
University at Buffalo School of Pharmacy and Pharmaceutical Sciences
Ashley Woodruff Pharm.D., BCPS
University at Buffalo School of Pharmacy and Pharmaceutical Sciences