Evaluation of unfractionated heparin versus low-molecular-weight heparin and fondaparinux for pharmacologic venous thromboembolic prophylaxis in critically ill patients with cancer.
J Thromb Haemost. 2018 Oct 22;:
Authors: Van Matre ET, Reynolds PM, MacLaren R, Mueller SW, Wright GC, Moss M, Burnham EL, Ho PM, Vandivier RW, Kiser TH
BACKGROUND: Critically ill patients with cancer are at increased risk of venous thromboembolism (VTE) from physical and cellular factors, requiring pharmacologic prophylaxis to reduce the risk of VTE.
OBJECTIVES: To assess whether low-molecular-weight heparin (LMWH) prophylaxis reduces in-hospital rates of VTE or improves clinical outcomes compared to unfractionated heparin (UFH) prophylaxis in critically ill patients with cancer.
METHODS: Propensity matched comparative effectiveness cohort Premier Database study. Patients 18 years or older with the primary diagnosis of cancer, intensive care unit admission and VTE prophylaxis within 2 days of admission between January 1, 2010 and December 31, 2014 were included. Patients were divided into LMWH or UFH prophylaxis groups.
RESULTS: 103,798 patients were included, 75,321 (72.6%) patients received LMWH and 28,477 (27.4%) patients received UFH. Propensity analysis matched (2:1) 42,343 LMWH patients and 21,218 UFH patients. Overall, LMWH was not associated with decreased incidence of VTE (5.32% vs. 5.50%). LMWH prophylaxis was associated with a reduction in pulmonary embolism (0.70% vs 0.99%), significant bleeding (13.3% vs 14.8%), and heparin induced thrombocytopenia (HIT) (0.06% vs 0.19%). In non-metastatic solid disease, LMWH was associated with decreased VTE (4.27% vs. 4.84%) and PE (0.47% vs. 0.95%).
CONCLUSIONS: The use of a LMWH VTE prophylaxis was not associated with a reduction in the incidence of in-hospital VTE as compared to UFH, but was associated with significant reduction in clinically important bleeding events and incidence of HIT in critically ill patients with cancer. This article is protected by copyright. All rights reserved.
PMID: 30347498 [PubMed - as supplied by publisher]