{'fraction_non_alphanumeric': 0.038317757009345796, 'fraction_numerical': 0.03271028037383177, 'mean_word_length': 5.082386363636363, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
480: DOSING OF THROMBOPROPHYLAXIS BY VARIOUS ANTHROPOMETRIC STRATIFICATION ARE WE MISSING THE MARK?

Learning Objectives: Prevention of venous thromboembolism during critical illness is standard of care. Extremes of body weight are associated with bleeding or treatment failure in patients receiving pharmacologic thromboprophylaxis (PTP). Although adjustments are warranted, consensus for dosing in extremes of body weight are lacking and evidence is diverse due to variability in anthropometric stratification. The purpose of this study was to describe the prevalence of inappropriately dosed ENOX and UFH in critically ill adults. Methods: This was a post-hoc analysis of a nested cohort from a previous cross–sectional study of critically ill adults across nine institutions. Patients receiving PTP with enoxaparin (ENOX) or unfractionated heparin (UFH) were included. The primary outcome was the prevalence of inappropriate dosing based on body mass index (BMI) and total body weight (TBW). Appropriate dosing was defined as a total daily dose for ENOX and UFH stratified by BMI and TBW that was most congruent with current evidence. A secondary outcome was to identify risk factors for inappropriate dosing. Multivariable generalized linear mixed-effect models were constructed to determine independent risk factors for inappropriate dosing of PTP. Results: The nested cohort included 172 patients (ENOX=46, UFH=126). Inappropriate dosing was observed in 118 patients (68.6%) based on BMI and 74 (43%) per TBW. Independent risk factors for inappropriate dosing per BMI were receipt of UFH (OR 6.93, 95% CI 1.06–8.77) or a BMI underweight or overweight/ obese (OR 10.45, 95% CI 4.38–24.92). Receiving UFH (OR 3.02, 95% CI 1.05–8.70) or a TBW 100kg (OR 5.7, 95% CI 2.46–13.16) were independently associated with inappropriate dosing based on TBW. Conclusions: Inappropriate dosing of PTP occurs frequently in critically ill adults receiving ENOX or UFH. This was most notably seen in body size extremes or when UFH was used. Comparative dosing strategies in predefined subgroups of body size are warranted to assess safety and efficacy.