Critical care folks: what are your thoughts on using any other full dose anticoagulant (DOACs, enoxaparin) besides heparin drip in the ICU? 💉 I get a lot of pushback from providers who say “you never know when someone needs a procedure” so I need some outside input! 🤔 - ThreadSky

austincamp.bsky.social • 28 days ago

Critical care folks: what are your thoughts on using any other full dose anticoagulant (DOACs, enoxaparin) besides heparin drip in the ICU? 💉

I get a lot of pushback from providers who say “you never know when someone needs a procedure” so I need some outside input! 🤔

Comments

stevenmathern.bsky.social•28 days ago

actually let's ask @bradspellberg.bsky.social also ;)

bradspellberg.bsky.social•28 days ago

I have no real input on this one. I think it depends on the likelihood that a procedure will be needed, and I see SQ lovenox used all the time.

stevenmathern.bsky.social•28 days ago

thank you for helping

stevenmathern.bsky.social•28 days ago

enoxaprin is superior was my understanding
@imcrit.bsky.social @pulmcrit.bsky.social ?

imcrit.bsky.social•28 days ago

@austincamp.bsky.social‬
I don't use DOAC or warfarin until pt has left the ICU or I am off service 😊
Heparin drip versus enoxa is a bit trickier. Do we prefer something that is potentially rapidly reversible & there is antidote (protamine) or a long(er) acting with protamine being less effective?

imcrit.bsky.social•28 days ago

It's very difficult to see a perfect study comparing the two in ICU patients. I tend to use drugs with shortest action but I aim for the lower end of the therapeutic range or use "my own protocol" 😊

resprate16.bsky.social•28 days ago

dumb question: why enox over dalteparin?

imcrit.bsky.social•28 days ago

No dalte in my hospital

austincamp.bsky.social•28 days ago

I think that’s pretty much the default at least in the US. I’ve never seen dalteparin in real life personally!

austincamp.bsky.social•28 days ago

I’ll just throw in a benefit for non heparin drip anticoag is less work on nurses! But agreed there are several factors to consider and there’s good argument for what might be “safest”

stevenmathern.bsky.social•28 days ago

less nurse work... but also there was a recent study showing better anticoagulation... that heparin gtt took like over 24hrs just to get theraputic... did u see it?

austincamp.bsky.social•28 days ago

I haven’t seen it, I’ll have to look it up! That would be something more tangible I can show my Intensivists.

pulmcrit.bsky.social•28 days ago

https://bsky.app/profile/pulmcrit.bsky.social/post/3lh2yaopw2c2o

amywski.bsky.social•28 days ago

Warfarin and DOACs: definite no, too tricky to reverse and usually kidney function doesn’t allow.

We often use Treatment LMWH once we know they definitely don’t need any more surgery or if concerned RE:bleeding we split the dose to BD.

imcrit.bsky.social•28 days ago

@stevenmathern.bsky.social

https://academic.oup.com/eurheartj/article/45/Supplement_1/ehae666.3326/7838398

stevenmathern.bsky.social•28 days ago

boy are u good at finding stuff.
.
maybe this one also?:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2828658

pulmcrit.bsky.social•28 days ago

enoxaparin is fine

the SECOND you start a doac they will have GI bleed or need a procedure. its the murphy’s law of doacs. unless someone isn’t truly icu-level illness I avoid doacs.

stevenmathern.bsky.social•28 days ago

Dr Farkas--thank you very much for teaching me and others

pulmcrit.bsky.social•28 days ago

thank you 🙏🙏

emilyfri.bsky.social•28 days ago

Decerebrate use of heparin gtt really irritates me. I use tx dose lovenox most often if someone actually needs a/c but is sick enough that they I’m concerned about them. If they just barely need the ICU I don’t interrupt the DOAC. Also I don’t bridge AF in ICU.

Comments

Posting Rules

Reply