LAUSR

Introduction/Hypothesis: Venous thromboembolism (VTE) prophylaxis dosing strategies in the neurocritically ill are not well defined. The utilization of a body mass index (BMI) dosing strategy for VTE pharmacoprophylaxis is unknown in patients with hemorrhagic strokes. The purpose of this study was to determine the safety of early initiation of VTE prophylaxis based on BMI for patients with aneurysmal subarachnoid hemorrhage (aSAH) or spontaneous intracerebral hemorrhage (sICH). Methods: This was a retrospective, single-center, cohort study comparing heparin dosing strategies for venous thromboembolism (VTE) prophylaxis in patients with aneurysmal subarachnoid hemorrhage (aSAH) and spontaneous intracerebral hemorrhage (sICH). Patients received either the standard dosing of heparin 5000 units subcutaneously every 12 hours or a body mass index (BMI) dosing strategy for VTE prophylaxis. Patients in the BMI dosing group received heparin 2500 units, 5000 units, or 7500 units subcutaneously every 8 hours. Outcomes measured included the incidence of major bleeding, minor bleeding, and time to heparin initiation. Results: A total of 168 patients in the standard dosing (n = 75) and BMI dosing (n = 93) groups were included in the analysis. No patients experienced a major bleed in either group. There were 5 (6.7%) minor bleeds in the standard dosing group versus 3 (3.2%) in the BMI dosing group, p = 0.47. The median time to the first dose of heparin from admission was 45.1 hours in the standard dosing compared to a median of 39.9 hours in the BMI dosing group (p < 0.01). Conclusions: Early initiation of subcutaneous heparin with BMI based dosing for VTE prophylaxis in patients with aSAH or sICH was not associated with an increased incidence of major or minor bleeding. Further studies are needed to determine the incidence of VTE between the two dosing regimens.