Pre/Post Evaluation of a VTE Prophylaxis Pathway With Weight-Based Dosing at a Level 1 Trauma Center

Sunday, March 22, 2026

11:00 AM - 12:00 PM Central Time

Location: Connections Central - RST 09

Lindey C. Lane, PharmD, MS

University of Kentucky HealthCare, Kentucky

Disclosure(s): No relevant financial relationship(s) to disclose.
BW

Brittany Wooten, N/A

PharmD Candidate
University of Tennessee Health Science Center, Tennessee

Disclosure information not submitted.
Joseph M. Swanson, PharmD, FCCP, FCCM (he/him/his)

University of Tennessee Health Science Center, Mississippi

Disclosure information not submitted.
CW

Christopher Wood, PharmD, FCCP, FCCM, BCCCP

Professor
University of Tennessee Health Science Center

Disclosure information not submitted.
DF

Dina Filiberto, MD, MS

Associate Professor of Surgery
University of Tennessee Health Science Center

Disclosure information not submitted.
AK

Andrew Kerwin, MD, FACS

Professor, Vice Department Chair, Surgery, Trauma/Surgical Critical Care
University of Tennessee Health Science Center

Disclosure information not submitted.
SB

Saskya Byerly, MD, MS

Assistant Professor of Surgery
University of Tennessee Health Science Center

Disclosure information not submitted.
EL

Emily Lenart, DO

Assistant Professor of Surgery
University of Tennessee Health Science Center

Disclosure information not submitted.
JF

Julie Farrar, PharmD, BCCCP

Assistant Professor of Clinical Pharmacy and Translational Science
University of Tennessee College of Pharmacy

Disclosure information not submitted.

Introduction: Venous thromboembolism (VTE) remains a significant cause of morbidity and mortality in critically ill trauma patients. Low-molecular-weight heparin (LMWH) is the preferred pharmacologic agent in these patients, although unfractionated heparin (UFH) may also be indicated. This study evaluated the safety and efficacy of a new VTE prophylaxis pathway utilizing a stratified weight-based approach.

Methods: Patients admitted to the trauma ICU and administered VTE prophylaxis for ≥48 hours were screened. Patients receiving VTE prophylaxis based on a previous iteration of the clinical pathway (July 2022-June 2023; PRE group) were compared to those provided VTE prophylaxis based on a new pathway (July 2023-June 2024; POST group) including LMWH 60mg q12h, 80mg q12h, and UFH 7500 units q8h as initiation options based on weight. The primary outcome was incidence of VTE. Secondary outcomes included major bleeding as defined by ISTH criteria, bleeding requiring takeback to the operating room, and incidence of each component of major bleeding.

Results: Of 871 screened, 671 patients were included in the study. Two hundred and ninety-five patients were included in the PRE group and 341 patients were included in the POST group. Injuries were most often due to a blunt mechanism (82%), and the median (IQR) Injury Severity Score was 16 (9-22). No significant differences existed at baseline. More patients in the POST group were initiated on LMWH than UFH, and time to initiation was shorter (15.3 [9.9-26] days vs 12.5 [8.8-22.4] days; p=0.002). More patients in the PRE group underwent anti-factor Xa monitoring (43.7% vs 25.1%; p< 0.001). The median weight-based LMWH dose in the PRE group was 0.44 mg/kg (0.35, 0.53) compared to 0.47 mg/kg (0.39, 0.55) in the POST group (p=0.04). VTE was not significantly different (3.7% vs 2.6%; p=0.42). On univariate analysis major bleeding was not significantly different (13.6% vs 9%; p=0.07), and no individual components of major bleeding were different. However, on multivariable logistic regression, the POST group was half as likely to experience major bleeding (OR 0.50 [95% CI 0.28-0.85]).

Conclusions: Use of a stratified weight-based approach to VTE prophylaxis initiation was as efficacious and did not result in excess bleeding.