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

Abstract

BACKGROUND:Both unfractionated heparin (UFH) and low‐molecular‐weight heparin (LMWH) are approved for venous thromboembolism (VTE) prophylaxis. Which agent is superior remains controversial.OBJECTIVE:To compare the effectiveness, complications, and costs of UFH and LMWH as VTE prophylaxis for hospitalized medical patients.DESIGN:Retrospective cohort.SETTING:Three hundred thirty‐three acute care facilities in 2004–2005.PATIENTS: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.INTERVENTION:None.MEASUREMENTS: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).CONCLUSIONS:For VTE prophylaxis, the effectiveness and cost of LMWH and UFH are similar, but LMWH is associated with fewer complications. Journal of Hospital Medicine 2012;. © 2012 Society of Hospital Medicine

Heparin and related drugs for venous thromboembolism prophylaxis: subcutaneous or intravenous continuous infusion?

“…The results supported use of UFH for VTE prophylaxis in medical patients presenting with an acute medical illness. Although no significant differences in the efficacy of LMWH and UFH was reported, however, a significant reduction in risk of bleeding was detected in LMWH group [81,82].…”

Diagnosis and Management of Heparin-Induced Thrombocytopenia

“…In a meta-analysis involving 13 studies and > 5,000 patients, the rates of HIT were comparable in patients receiving UFH or LMWH (LMWH 1.2% vs UFH 1.5%). 13 Surprisingly, no increase in HIT incidence has been reported 17,18 despite the increased utilization of LMWHs in recent years for the prevention of hospital-acquired VTE. Although rates of seroconversion are similar for fondaparinux and LMWH, 19 the occurrence of HIT appears to be infrequent with fondaparinux.…”

An unusual presentation of heparin-induced thrombocytopenia in the setting of catheter-directed ablation of atrial fibrillation

“…In a recent study of 25 653 medical inpatients, the incidence of HIT was less than 0.2% in patients who received LMWH, with all cases occurring in those who received therapeutic doses of LMWH [5]. Other studies in medical patients have reported similar low rates of thrombocytopenia and HIT with LMWH [7][8][9][10]. Other studies in medical patients have reported similar low rates of thrombocytopenia and HIT with LMWH [7][8][9][10].…”