Intermittent Subcutaneous Unfractionated Heparin for Venous Thromboembolism Prophylaxis in Pediatric Intensive Care Unit Patients

BACKGROUND: Venous thromboembolism (VTE) is a recognized complication in the pediatric intensive care unit (PICU) that has become more common over the past decade. While intermittent subcutaneous unfractionated heparin (sUFH) is used for VTE prophylaxis in adults, there is limited evidence guiding its use in the pediatric population. sUFH offers advantages for patients with renal dysfunction, limited intravenous access, or uncertain surgical plans due to its short half-life, reversibility, and ease of titration. Given the paucity of pediatric data, further characterization of its prophylactic use is warranted. METHODS: This retrospective cohort study included PICU patients (≤ 18 years) at a single quaternary pediatric hospital (July 2014-June 2024) who received sUFH for VTE prophylaxis for ≥ 24 h. Data collected included dosing, frequency, monitoring, incidence of bleeding, and incidence of VTE. RESULTS: Sixty-six patients met the inclusion criteria. The median dose administered was 89.3 units/kg (IQR, 73.5-109.6), with dosing intervals evenly divided between every 8 and 12 h. Seven patients (11%) developed VTE and 16 patients (24%) experienced bleeding. Median doses did not differ significantly between those with and without VTE (109.6 vs. 84.7 units/kg, p = 0.6) or bleeding (86.9 vs. 89.1 units/kg, p = 0.9). CONCLUSIONS: In this cohort, bleeding events were more common than thrombotic events and occurred in 24% of patients, while VTE developed in 11%. These findings highlight the need for more standardized dosing strategies and further prospective evaluation to better define the safety and effectiveness of sUFH for VTE prophylaxis in the PICU.