Thromboprophylaxis in individuals with obesity in the ICU

James Douketis, MD, is a professor of medicine and the David Braley-Nancy Gordon Chair in Thromboembolic Disease at McMaster University.

How to prevent thrombosis in a patient with obesity in the intensive care unit (ICU)?

Obesity is a problem that we’re seeing more and more in all parts of the world. Previously, when we had studied methods of prophylaxis, these were based on studies that involved patients who typically weighed ≤100 kg. Now, we may have patients in the hospital who are 120 kg, 130 kg, or even more in terms of their weight.

The question is, is the standard dose of prophylaxis—for example, unfractionated heparin 5000 units twice a day or low-molecular-weight heparin once a day—is that enough in terms of prophylactic efficacy?

We don’t have a good answer to that question. But many clinicians, what they will do is increase the dose by 50% for patients who may be >100 kg or 110 kg because it’s unlikely to cause more harm or increase the risk of bleeding and it may increase the bioavailability, and therefore the efficacy, of that drug to prevent thrombosis in an obese individual who was hospitalized.