Comparative effectiveness of low-molecular-weight heparin versus unfractionated heparin for thromboembolism prophylaxis for medical patients

Journal of Hospital Medicine, 04/25/2012

Rothberg MB et al. - For venous thromboembolism (VTE) prophylaxis, the effectiveness and cost of low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) are similar, but LMWH is associated with fewer complications.

Methods

  • Retrospective cohort.
  • Three hundred thirty-three acute care facilities in 2004–2005.
  • Adults with 4 common medical diagnoses considered to carry moderate-to-high risk of VTE.
  • Excluded were patients on warfarin or with hospital stays of ≤2 days.
  • VTE prophylaxis was assessed from billing data.
  • VTE, major bleeding or heparin-induced thrombocytopenia, mortality, and cost.

Results

  • Of 32,104 patients who received prophylaxis, 55% received LMWH and the remainder received UFH.
  • The hospital where the patient obtained care was the strongest predictor of receiving LMWH.
  • VTE was observed in 163 (0.51%) patients; complications, followed by stopping therapy, were rare (<0.2%).
  • In analysis adjusted for the propensity for UFH and other covariates, patients treated with UFH had an odds ratio for VTE of 1.04 (95% confidence interval [CI] 0.76 to 1.43) compared to LMWH.
  • In a grouped treatment model, the odds of VTE with UFH was 1.14 (95% CI 0.72 to 1.81).
  • Adjusted odds of bleeding with UFH compared to LMWH were 1.64 (95% CI 0.50 to 5.33), adjusted odds of complications followed by stopping prophylaxis were 2.84 (95% CI 1.43 to 45.66), and adjusted cost ratio was 0.97 (95% CI 0.90 to 1.05).

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