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Evaluating the safety and effectiveness of venous thromboembolism prophylaxis in patients with sickle cell disease

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Abstract

Nearly every component of hemostasis is altered in sickle cell disease (SCD), yet little evidence exists to guide utilization of venous thromboembolism prophylaxis (VTEP) in this population. This retrospective cohort study included 135 adult patients admitted with a diagnosis of SCD vaso-occlusive crisis to the general medicine service at a tertiary care academic medical center from August 1, 2011 to August 1, 2013. If VTEP was discontinued, the medical record was reviewed for suspicion of VTE, hemorrhage, heparin-induced thrombocytopenia (HIT), or other adverse events. The primary objective was to characterize the safety and effectiveness of VTEP in SCD. The secondary objective was to assess the correlation of VTE with risk factors documented in the general medical population. Most patients (116/135, 85.9%) were prescribed VTEP upon admission, with early discontinuation in 23 patients (19.8%). Reasons for discontinuation included suspicion of VTE (10/116, 8.6%), hemorrhage (5/116, 4.3%), and/or HIT (4/116, 3.4%). Since patients with SCD receiving standard VTEP regimens appear to have similar outcomes compared to medically ill patients in prospective studies, using these regimens appears to be safe when indicated in the opinion of the provider. Once daily injections may be preferred in order to optimize adherence.

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Acknowledgements

This project was supported by the South Carolina Clinical and Translational Research (SCTR) Institute, with an academic home at the Medical University of South Carolina, through NIH Grant Number UL1 TR000062. I would like to acknowledge Petra A. Aldridge, MS for her contributions to statistical analysis.

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Authors and Affiliations

  1. Department of Pharmacy, UF Health Jacksonville Medical Center, Jacksonville, FL, 32209, USA

    Denise Kelley

  2. Department of Pharmacy, Ralph H. Johnson VA Medical Center, Charleston, SC, 29425, USA

    Lauren Thornton Jones

  3. Presbyterian College of Pharmacy, Clinton, SC, 29325, USA

    Jun Wu

  4. Medical Univeristy of South Carolina College of Pharmacy, 280 Calhoun Street QE 205, Charleston, SC, 29425, USA

    Nicole Bohm

Authors
  1. Denise Kelley
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  2. Lauren Thornton Jones
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  3. Jun Wu
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  4. Nicole Bohm
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Correspondence to Nicole Bohm.

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The authors have nothing to disclose concerning personal or financial relationships with commercial entities.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Board deemed informed consent not necessary for this study.

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Kelley, D., Jones, L.T., Wu, J. et al. Evaluating the safety and effectiveness of venous thromboembolism prophylaxis in patients with sickle cell disease. J Thromb Thrombolysis 43, 463–468 (2017). https://doi.org/10.1007/s11239-016-1463-z

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  • DOI: https://doi.org/10.1007/s11239-016-1463-z

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