{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T11:54:59Z","timestamp":1783338899014,"version":"3.54.6"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,1,21]],"date-time":"2019-01-21T00:00:00Z","timestamp":1548028800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100013607","name":"American College of Clinical Pharmacy","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013607","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Venous thromboembolism (<jats:styled-content style=\"fixed-case\">VTE<\/jats:styled-content>) occurs frequently in critically ill patients without heparin prophylaxis. Although heparin prevents <jats:styled-content style=\"fixed-case\">VTE<\/jats:styled-content>,<jats:styled-content style=\"fixed-case\"> VTE<\/jats:styled-content>s occur frequently despite prophylaxis. A higher heparin dosage may be more effective for preventing <jats:styled-content style=\"fixed-case\">VTE<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective study was conducted using the Premier Incorporated Perspective Database to evaluate comparatively the effects of different heparin prophylaxis dosing strategies in the critically ill patient. Critically ill adult patients who were mechanically ventilated for at least 1\u00a0day and had an intensive care unit (<jats:styled-content style=\"fixed-case\">ICU<\/jats:styled-content>) length of stay of at least 2\u00a0days were included. Patients received 5000\u00a0units of heparin either twice\/day or 3 times\/day. The primary outcome was development of a new <jats:styled-content style=\"fixed-case\">VTE<\/jats:styled-content>. Key secondary outcomes included clinically important bleeding, thrombocytopenia, and mortality. Patients were propensity matched to control for confounding. Multivariable analysis was conducted for <jats:styled-content style=\"fixed-case\">VTE<\/jats:styled-content> risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study included 30,800 patients from 374 hospitals who were propensity matched by heparin dosage. New <jats:styled-content style=\"fixed-case\">VTE<\/jats:styled-content> occurred in 6.16% of patients treated with 3 times\/day heparin versus 6.23% with <jats:styled-content style=\"fixed-case\">twice\/day <\/jats:styled-content>heparin (p=0.8). No significant differences in the incidence of pulmonary embolism (0.91% vs 0.8%, p=0.29) or deep vein thrombosis (5.56% vs 5.70% p=0.59) were observed between the two types of heparin dosing. No differences were observed between the two types of heparin dosing in in\u2010hospital mortality (15.8% vs 15.15%), bleeding (0.23% vs 0.33%), or thrombocytopenia (5.19% vs 5.34%, p&gt;0.08 for all), respectively. Risk factors associated with <jats:styled-content style=\"fixed-case\">VTE<\/jats:styled-content> included intraabdominal and urinary tract infections, loop diuretics, malnutrition, obesity, thrombocytopenia, paralytics, vasopressors, female sex, peripheral vascular disease, sepsis, neutropenia, and end\u2010stage renal disease. Antiplatelet therapy, heart failure, diabetes, and substance abuse were associated with reduced <jats:styled-content style=\"fixed-case\">VTE<\/jats:styled-content> (p&lt;0.05 for all).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In critically ill patients, prophylactic dosing of heparin 3 times\/day versus twice\/day was not associated with differences in new <jats:styled-content style=\"fixed-case\">VTE<\/jats:styled-content> or safety outcomes. Several modifiable <jats:styled-content style=\"fixed-case\">VTE<\/jats:styled-content> risk factors were identified.<\/jats:p><\/jats:sec>","DOI":"10.1002\/phar.2212","type":"journal-article","created":{"date-parts":[[2018,12,28]],"date-time":"2018-12-28T11:38:39Z","timestamp":1545997119000},"page":"232-241","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Evaluation of Prophylactic Heparin Dosage Strategies and Risk Factors for Venous Thromboembolism in the Critically Ill Patient"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7159-0517","authenticated-orcid":false,"given":"Paul M.","family":"Reynolds","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora 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