Volume 83, Issue 10 (January 2025)
Tehran Univ Med J. 2025, 83(10): 705-713 |
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Vatankhah Tarbehbar M, Kashani S, Mohammadi M, Mahmoudi M, Ashena M A, Malekshoar M et al . heparin, intensive care unit, intravenous injection, subcutaneous injection, venous thromboembolism.. Tehran Univ Med J. 2025; 83 (10) :705-713
URL: http://tumj.tums.ac.ir/article-1-13881-en.html
URL: http://tumj.tums.ac.ir/article-1-13881-en.html
heparin, intensive care unit, intravenous injection, subcutaneous injection, venous thromboembolism.
Majid Vatankhah Tarbehbar1, Saeed Kashani1, Milad Mohammadi1, Masoumeh Mahmoudi1, Mohammad Ali Ashena1, Mehrdad Malekshoar *2, Ehsan Ramazanian Nik1
1- Department of Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
2- Department of Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. ,mdmalekshoar@gmail.com
2- Department of Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. ,
Abstract: (20 Views)
Background: Critical illness, extended immobility, mechanical ventilation, and major surgery make ICU patients susceptible to VTE. Unfractionated heparin is the usual preventative, but its subcutaneous or intravenous administration is disputed. Subcutaneous injections eliminate the need for patient monitoring; however, critically sick patients with unstable hemodynamics, edema, or vasopressors may not absorb the medicine. Continuous intravenous infusion is superior for prophylactic anti-factor Xa levels, especially in obese and critically ill surgical patients, although it might induce bleeding and must be monitored. Many studies have failed to determine the appropriate ICU strategy for all patients. This study evaluated subcutaneous and intravenous heparin for ICU VTE prophylaxis.
Methods: This randomized double-blind clinical trial was conducted at Shahid Mohammadi Hospital ICU in Bandar Abbas, Iran, from October 2023 to March 2024. According to ICOPER standards, 112 patients who needed heparin prophylaxis were randomly assigned to receive either subcutaneous or intravenous heparin (5000 units twice daily, n=56). Patients, attending physicians, nurses (except for the nurse who administered the treatment), and outcome assessors were unaware of the treatment allocation. Every day, they measured the circumference of the lower limb (10 cm below the tibial tuberosity), the platelet count, the PT, the PTT, and the INR. Doppler ultrasonography was performed when the difference in limb circumference exceeded 2 cm. We used independent t-tests, Mann-Whitney U tests, chi-square tests, and logistic regression to look at the data. The level of significance was set at P<0.05.
Results: The average platelet count in the subcutaneous group (248.14×1000/μL) was much higher than in the intravenous group (144.23×1000/μL) (P<0.001). The subcutaneous group exhibited an extended prothrombin time (P=0.004). The incidence of PTT, INR, and VTE was comparable across groups. Using logistic regression, the only important predictor of VTE in both groups was the difference in size of the lower limbs.
Conclusion: A stable ICU Due to its higher platelet counts and decreased bleeding, subcutaneous heparin may be used for long-term prophylaxis. For immediate anticoagulation and precise management, intravenous injection is ideal. The patient's clinical condition, sickness severity, and therapeutic needs should determine treatment.
Methods: This randomized double-blind clinical trial was conducted at Shahid Mohammadi Hospital ICU in Bandar Abbas, Iran, from October 2023 to March 2024. According to ICOPER standards, 112 patients who needed heparin prophylaxis were randomly assigned to receive either subcutaneous or intravenous heparin (5000 units twice daily, n=56). Patients, attending physicians, nurses (except for the nurse who administered the treatment), and outcome assessors were unaware of the treatment allocation. Every day, they measured the circumference of the lower limb (10 cm below the tibial tuberosity), the platelet count, the PT, the PTT, and the INR. Doppler ultrasonography was performed when the difference in limb circumference exceeded 2 cm. We used independent t-tests, Mann-Whitney U tests, chi-square tests, and logistic regression to look at the data. The level of significance was set at P<0.05.
Results: The average platelet count in the subcutaneous group (248.14×1000/μL) was much higher than in the intravenous group (144.23×1000/μL) (P<0.001). The subcutaneous group exhibited an extended prothrombin time (P=0.004). The incidence of PTT, INR, and VTE was comparable across groups. Using logistic regression, the only important predictor of VTE in both groups was the difference in size of the lower limbs.
Conclusion: A stable ICU Due to its higher platelet counts and decreased bleeding, subcutaneous heparin may be used for long-term prophylaxis. For immediate anticoagulation and precise management, intravenous injection is ideal. The patient's clinical condition, sickness severity, and therapeutic needs should determine treatment.
Keywords: heparin, intensive care unit, intravenous injection, subcutaneous injection, venous thromboembolism.
Type of Study: Original Article |
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