Alcohol use disorder was not independently associated with increased VTE risk in a national analysis of 2.07 million alcohol-related hospitalizations (VTE prevalence 0.71%; 95% CI 0.68-0.74).
Case Report (n=2,070,000)
Yes
Standard fixed-dose enoxaparin prophylaxis may fail in certain patients, though alcohol use disorder itself does not independently increase VTE risk based on a large national analysis.
Abstract Introduction Venous thromboembolism (VTE) remains a major preventable cause of inpatient morbidity and mortality. Despite guideline-directed prophylaxis, breakthrough events may still occur. This case describes a massive pulmonary embolism (PE) in a medically stable patient receiving standard prophylaxis and examines whether alcohol use disorder (AUD) confers increased VTE risk. Case Report A 56-year-old male with alcohol use disorder was admitted for recurrent falls and complicated withdrawal. After stabilization, he received enoxaparin 40 mg subcutaneously daily for prophylaxis. On hospital day fifteen, he collapsed while ambulating and experienced pulseless electrical activity arrest. Return of spontaneous circulation was achieved after five minutes. Bedside echocardiography showed right ventricular strain, and CT angiography confirmed bilateral massive PE. He underwent successful mechanical thrombectomy with full recovery. Discussion This case highlights a rare failure of fixed-dose enoxaparin despite adherence to standard prophylaxis. Guidelines from CHEST, ASH, and ASCO recommend low molecular weight heparin (LMWH) as first-line prophylaxis, with dose adjustment for obesity, immobility, or systemic inflammation. Direct oral anticoagulants (DOACs) offer extended-duration options but are limited by bleeding and renal considerations. Furthermore, the patient’s only known chronic condition—alcohol use disorder—was evaluated in a national analysis of 2.07 million alcohol-related hospitalizations (2017-2022), which found a VTE prevalence of 0.71 % (95 % CI 0.68-0.74) and an adjusted predicted probability of 0.56 % (95 % CI 0.53-0.59). Alcohol use disorder was not independently associated with increased VTE risk, indicating that alcohol-related admissions do not carry elevated VTE risk and underscore the need for ongoing risk reassessment during hospitalization. This abstract is funded by: None
Cho et al. (Fri,) conducted a case report in Venous thromboembolism (VTE) (n=2,070,000). Enoxaparin was evaluated on VTE prevalence (95% CI 0.68-0.74). Alcohol use disorder was not independently associated with increased VTE risk in a national analysis of 2.07 million alcohol-related hospitalizations (VTE prevalence 0.71%; 95% CI 0.68-0.74).