HHS – full or prophylactic anticoagulation?

Authors

  • Georgina Wordsworth CT1, Royal United Hospital, Bath, UK.
  • Anthony Robinson Consultant, Department of Diabetes and Endocrinology, Royal United Hospital, Bath, UK
  • Alexandra Ward Consultant, Department of Diabetes and Endocrinology, Royal United Hospital, Bath, UK
  • Marc Atkin Consultant, Department of Diabetes and Endocrinology, Royal United Hospital, Bath, UK

DOI:

https://doi.org/10.15277/bjdvd.2014.011

Abstract

Diabetes mellitus and, in particular, the hyperosmolarity associated with the hyperosmolar hyperglycaemic state (HHS) is associated with an increased risk of thrombotic events. This risk is acknowledged by the authors of the national HHS guideline who recommend prophylactic low molecular weight heparin (LMWH) for all patients with HHS for the full duration of their admission.

We present a case of fatal pulmonary embolism in a 39-year old man admitted with HHS who was treated according to local hospital trust and national guidance with prophylactic LMWH.

In the absence of evidence from randomised studies comparing prophylactic and treatment dose anti- coagulation in thrombosis prevention in HHS further research is needed to facilitate development of evidence-based guidelines.

References

Grant PJ. Diabetes mellitus as a prothrombotic condition. J Intern Med 2007;262:157-72. http://dx.doi.org/10.1111/j.1365-2796.2007.01824.x

Keenan CR, Murin S, White RH. High risk for venous thromboembolism in diabetics with hyperosmolar state: comparison with other acute medical illnesses. J Thromb Haemost 2007;5(6):1185-90. http://dx.doi.org/10.1111/j.1538-7836.2007.02553.x

Shujaat A, Shapiro JM. Massive pulmonary embolism in diabetic ketoacidosis and non-ketotic hyperosmolar state: case series and review of the literature. Clinical Intensive Care 2004;15(2-3):73-77. http://dx.doi.org/10.3109/09563070410001711771

Joint British Diabetes Societies Inpatient Care Group. The management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes. August 2012. http://www.diabetes.org.uk/Documents/Position% 20statements/JBDS-IP-HHS-Adults.pdf

Engbers MJ, van Hylckama Vlieg A and Rosendaal FR. Venous thrombosis in the elderly: incidence, risk factors and risk groups. J Thromb Haemost 2010;8(10):2105-12.

Belch JJ, Lowe GD, Ward AG, et al. Prevention of deep vein thrombosis in medical patients by low-dose heparin. Scott Med J 1981;26:115-7.

Keenan CR, Murin S, White RH. High risk for venous thromboembolism in diabetics with hyperosmolar state: comparison with other acute medical illnesses. J Thromb Haemost 2007;5(6):1185-90.

Green D, Lee MY, Ito VY, et al. Fixed vs adjusted-dose heparin in the prophylaxis of thromboembolism in spinal cord injury. JAMA 1988;260 (9):1255-8. http://dx.doi.org/10.1001/jama.1988.03410090087036

Campbell NR, Hull RD, Brant R, et al. Aging and heparin-related bleeding. Arch Intern Med 1996;156(8):857-60. http://dx.doi.org/10.1001/archinte.1996.00440080047006

Small M, MacCuish AC. The hyperglycaemic, hyperosmolar non-ketotic syndrome: some aspects of management. Scott Med J 1987;32(2):35-7.

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Published

2014-06-09

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Section

Learning from practice