PMID- 17449088
OWN - NLM
STAT- MEDLINE
DCOM- 20080303
LR  - 20181201
IS  - 0049-3848 (Print)
IS  - 0049-3848 (Linking)
VI  - 121
IP  - 1
DP  - 2007
TI  - Venous thromboembolism after orthopedic surgery: implications of the choice for 
      prophylaxis.
PG  - 17-24
AB  - INTRODUCTION: Venous thromboembolism (VTE) is an important cause of morbidity and 
      mortality following major orthopedic surgeries. In clinical trials, fondaparinux 
      and low molecular weight heparins have been shown to be more effective than 
      unfractionated heparin (UFH) in preventing VTE. We retrospectively analyzed a 
      large hospital discharge database to assess the occurrence of clinically detected 
      VTE as a function of the injectable antithrombotic agent used for VTE prophylaxis 
      in orthopedic surgery. METHODS: The Premier's Perspective database, representing 
      over 500 hospitals across the US, was utilized to identify patients receiving 
      dalteparin, enoxaparin, fondaparinux, or UFH following hip or knee replacement or 
      hip fracture surgery between January 2003 and March 2005. The primary outcome was 
      the proportion of patients in each cohort with a VTE, while secondary outcomes 
      included VTE occurrence during index hospitalization, and proportion of patients 
      with a VTE-associated hospital readmission. RESULTS: A total of 144,806 patients 
      were included in the study. Significantly fewer fondaparinux patients experienced 
      a VTE event (1.5%) compared to enoxaparin (2.3%), dalteparin (2.1%), and UFH 
      (4.2%). After controlling for baseline covariates, the odds of experiencing a VTE 
      was significantly higher for other treatments when compared to fondaparinux (odds 
      ratios: dalteparin=1.22 [95% CI: 1.01 to 1.46] p=0.0370; enoxaparin=1.39 [1.19 to 
      1.62], p<0.0001; UFH=1.98 [1.67 to 2.34], p<0.0001). Significantly fewer 
      fondaparinux-treated patients experienced an event during the index 
      hospitalization or were readmitted for a VTE compared to other treatments. 
      CONCLUSIONS: Similar to clinical trial findings, patients receiving fondaparinux 
      in this study experienced fewer VTE events following orthopedic surgeries.
FAU - Shorr, Andrew F
AU  - Shorr AF
AD  - Pulmonary and Critical Care Medicine Section, Washington Hospital Center, 
      Washington, DC 20010, USA. afshorr@dnamail.com
FAU - Kwong, Louis M
AU  - Kwong LM
FAU - Sarnes, Matthew
AU  - Sarnes M
FAU - Happe, Laura
AU  - Happe L
FAU - Farrelly, Eileen
AU  - Farrelly E
FAU - Mody-Patel, Nikita
AU  - Mody-Patel N
LA  - eng
PT  - Journal Article
DEP - 20070420
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 0 (Enoxaparin)
RN  - 0 (Polysaccharides)
RN  - 9005-49-6 (Heparin)
RN  - J177FOW5JL (Fondaparinux)
RN  - S79O08V79F (Dalteparin)
SB  - IM
MH  - Aged
MH  - Chemoprevention/methods
MH  - Cohort Studies
MH  - Dalteparin/therapeutic use
MH  - Data Collection
MH  - Enoxaparin/therapeutic use
MH  - Female
MH  - Fondaparinux
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - Male
MH  - Orthopedic Procedures/*adverse effects
MH  - Polysaccharides/*therapeutic use
MH  - Postoperative Complications/*prevention & control
MH  - Premedication/*methods
MH  - Retrospective Studies
MH  - Venous Thromboembolism/etiology/*prevention & control
EDAT- 2007/04/24 09:00
MHDA- 2008/03/04 09:00
CRDT- 2007/04/24 09:00
PHST- 2006/10/27 00:00 [received]
PHST- 2007/02/05 00:00 [revised]
PHST- 2007/02/27 00:00 [accepted]
PHST- 2007/04/24 09:00 [pubmed]
PHST- 2008/03/04 09:00 [medline]
PHST- 2007/04/24 09:00 [entrez]
AID - S0049-3848(07)00080-1 [pii]
AID - 10.1016/j.thromres.2007.02.013 [doi]
PST - ppublish
SO  - Thromb Res. 2007;121(1):17-24. doi: 10.1016/j.thromres.2007.02.013. Epub 2007 Apr 
      20.