Safety and effectiveness of a risk-stratified venous thromboembolism prophylaxis algorithm in young people with cystic fibrosis. Issue 206 (October 2021)

• Record Type: Journal Article
• Authors: Holsteen, Page; Meier, Maxene; Brennan, Laney; VanHorn, Tracie; Kuldanek, Susan A.; Wang, Michael; Martiniano, Stacey L.
• Is Part Of: Thrombosis research. Issue 206(2021)
• Page Start: 36
• Page End: 41
• Publication Date: 2021-10
• Subjects: CF cystic fibrosis -- CFTR cystic fibrosis transmembrane conductance regulator -- CVC central venous catheter -- FEV1 forced expiratory volume in 1 s -- MRSA methicillin-resistant Staphylococcus aureus -- MSSA methicillin-susceptible Staphylococcus aureus -- SCDs sequential leg compression devices -- SVT superficial venous thrombosis -- VTE venous thromboembolism; Cystic fibrosis -- Pediatric -- Venous thromboembolism -- Venous thromboembolism prophylaxis -- Enoxaparin; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2021.07.007
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Background: People with cystic fibrosis (CF) have an increased risk of thrombosis due to acquired thrombophilia secondary to chronic systemic inflammation and central venous catheter use for treatment of pulmonary infections. The objective of this study is to determine the safety and effectiveness of a risk-stratified, venous thromboembolism (VTE) prophylaxis intervention. Methods: This single-center, IRB-approved, retrospective study assessed patients with CF admitted to our institution for treatment of a pulmonary exacerbation from 2017 to 2019. Data and outcomes were manually extracted from the electronic medical record and internal CF clinical database. Subject characteristics, calculated VTE risk, prophylaxis interventions prescribed, VTE incidence, and adverse events were captured. Results: A total of 135 CF patients had 354 admissions for pulmonary exacerbations in the time frame of the study. The majority of admissions (88.7%) were classified as moderate or high risk for VTE using the algorithm. Overall, VTE prophylaxis intervention determined by the algorithm was initiated in 36.2% of admissions. During the study period, no VTE events occurred. Four minor bleeding adverse effects were reported in patients receiving VTE chemical prophylaxis with enoxaparin (4.2%). Conclusions: This study provides the first reported outcomes following implementation of a risk-stratified VTE prophylaxis algorithm in hospitalized young people with CF. In this population at increased risk, use of risk-stratified prophylaxis was safe and effective in preventing VTE. Additional work to improve and maintain adherence to the algorithm and VTE prophylaxis interventions at our institution is planned and similar care should be considered at other pediatric CF care centers. Highlights: Novel risk-stratified thromboembolism prophylaxis protocol implemented in hospitalized, young people with cystic fibrosis Thromboembolism prophylaxis was effective and no deep vein thrombosis events occurred during study period. Thromboembolism prophylaxis was safe, including only rare, mild adverse events with enoxaparin.