AB239. SOH26AB_0166. Audit of prophylactic clexane prescription: are we dose adjusting correctly based on weight?

Background: Subcutaneous low molecular weight heparin (LMWH) is routinely prescribed for surgical patients upon admission to the hospital as thromboprophylaxis. Local guidelines require dose adjustment based on patient weight and renal function. Incorrect dosing can put patients at an increased risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) or bleeding if they are under- or over-dosed on LMWH, respectively. This audit aimed to assess compliance with guideline-based dose adjustment of LMWH and identify areas for improvement.

Methods: Data were collected on surgical patients on four wards in University Hospital Galway over the course of 2 days, who had been prescribed prophylactic clexane in order to assess whether their doses were in keeping with local guidelines. Completion of the venous thromboembolism (VTE) prophylaxis proforma, which is included in the patient drug prescribing Kardex, was also assessed.

Results: Of 52 patients audited, only 32 (62%) received the correct prophylactic dose of LMWH. Ten patients (19%) had no documented weight during admission. Among the 10 patients who required a weight-based dose adjustment, only 3 (30%) were dosed correctly. The VTE prophylaxis proforma, which already includes a dosing algorithm for weight and creatinine clearance, was not completed for any patient

Conclusions: A significant portion of our surgical patients are not receiving the correct dose of prophylactic anticoagulation as per local guidelines. This poses a risk to the patient themselves, increasing the risk of avoidable complications. Targeted interventions such as mandatory documentation of weight and completion of the VTE prophylaxis proforma are needed to enhance patient safety and reduce the additional burden these avoidable complications create.

Keywords: Audit; dose adjustment; low molecular weight heparin (LMWH); surgical patients; thromboprophylaxis