Comparison of Dalteparin and Enoxaparin for Deep Venous Thrombosis Prophylaxis in Patients with Spinal Cord Injury

Chiou‐Tan, Faye Y.; Garza, Héctor J. Maldonado; Chan, Kwai-Tung; Parsons, Ken; Donovan, William H.; Robertson, Claudia S.; Holmes, Sally Ann; Graves, Daniel E.; Rintala, Diana H.

doi:10.1097/01.phm.0000083671.27501.47

Cited by 54 publications

(32 citation statements)

References 16 publications

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“…Nineteen other trials enrolled diverse groups of moderately to severely injured patients, including eight trials in patients with spinal cord injury 30,[166][167][168][169][170][171][172] and four studies in patients with orthopedic injuries. [173][174][175][176] Studies evaluated both mechanical (eg, IPC, myostimulation, continuous passive motion) and pharmacologic (eg, LDUH, LMWH) interventions, but no randomized trials examined IVC fi lter placement or use of surveillance ultrasound.…”

Section: Explanation Of Evidence Profi Lesmentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,827

744

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(Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE ( ‫ف‬ 1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE ( ‫ف‬ 3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE ( ‫ف‬ 6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava fi lter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients. CHEST 2012; 141(2)(Suppl):e227S-e277SAbbreviations: CABG 5 coronary artery bypass graft; ES 5 elastic stockings; ICH 5 intracranial hemorrhage; IPC 5 intermittent pneumatic compression; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; QALY 5 quality-adjusted life year; RR 5 risk ratio; VCU 5 venous compression ultrasonography

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Section: Explanation Of Evidence Profi Lesmentioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,827

744

View full text Add to dashboard Cite

show abstract

“…The definitive reason for this cannot be offered, especially because an extended literature search has shown multiple studies and metanalyses comparing UFH with LMWH, but head to head comparisons of the different LMW heparins are few in number and these have claimed similar compliance, health status, deep venous thrombosis, and bleeding rates with both [11] while some studies have brought out that switching patients from enoxaparin to dalteparin was cost-effective [12]. However the DETECT trial has established the hypothesis that dalteparin 5,000 units subcutaneous (SC) daily may not be clinically non-inferior to enoxaparin 30 mg SC twice daily for venous thromboembolism prophylaxis in high-risk population and until an adequately powered, prospective noninferiority trial is performed, enoxaparin is supported by level 1 evidence and should be the prophylactic agent of choice [13].…”

Section: Discussionmentioning

confidence: 99%

A Study on the Effect of Low Molecular Weight on Potassium Homeostasis in Patients Administered Heparin for Thromboprophylaxis in a Tertiary Care Hospital

Shanmugapriya

Bhuvaneswari

2017

Int J Pharm Pharm Sci

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Objective: Low molecular weight heparin (LMWH) is an indirect thrombin inhibitor used clinically as an anticoagulant for thromboprophylaxis of patients at risk of deep vein thrombosis. The study was done to assess the magnitude of rise in serum potassium after administration of low molecular weight heparin comparing enoxaparin with dalteparin and to evaluate the frequency of clinically significant hyperkalemia in the population studied. Methods:The study was done as a prospective non-randomized observational study in a population of 32 patients started on heparin for thromboprophylaxis for deep venous thrombosis, pulmonary thromboembolism or stroke. Results:A statistically significant elevation in serum potassium was seen in patients treated with LMWH (p = 0.007). The magnitude of rise in potassium was significantly higher in enoxaparin (p = 0.008) than the dalteparin group (p = 0.447). A clinically relevant hyperkalemia of>5 mEq/l was seen in 25% of the population studied. Other important associations detected from the study were that the advancing age and increasing dose could be potential risk factors contributory to an accentuated rise in serum potassium which may culminate in clinically significant hyperkalemia. Conclusion:The study has highlighted that the likelihood of rise in potassium levels during LMWH therapy necessitates monitoring of serum potassium.

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“…In acute SCI, a small randomized trial comparing enoxaparin to dalteparin reported similar protection and bleeding between the two preparations (Chiou-Tan, 2003). There appears to be no difference in the effectiveness of prevention of VTE following SCI between the commercially available LMWH preparations.…”

Section: Rationale For Thromboprophylaxismentioning

confidence: 99%

Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd ed.

2016

Topics in Spinal Cord Injury Rehabilitation

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Comparison of Dalteparin and Enoxaparin for Deep Venous Thrombosis Prophylaxis in Patients with Spinal Cord Injury

Abstract: Similar compliance, health status, deep venous thrombosis, and bleeding rates were found between dalteparin and enoxaparin.

Cited by 54 publications

References 16 publications

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of VTE in Nonorthopedic Surgical Patients

A Study on the Effect of Low Molecular Weight on Potassium Homeostasis in Patients Administered Heparin for Thromboprophylaxis in a Tertiary Care Hospital

Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd ed.

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