PMID- 22057910
OWN - NLM
STAT- MEDLINE
DCOM- 20120312
LR  - 20220331
IS  - 1932-8737 (Electronic)
IS  - 0160-9289 (Print)
IS  - 0160-9289 (Linking)
VI  - 34
IP  - 11
DP  - 2011 Nov
TI  - Pharmacologic prophylaxis for venous thromboembolism and 30-day outcomes among 
      older patients hospitalized with heart failure: an analysis from the ADHERE 
      national registry linked to Medicare claims.
PG  - 682-8
LID - 10.1002/clc.20986 [doi]
AB  - BACKGROUND: Hospitalized medically ill patients are at greater risk for venous 
      thromboembolism (VTE). Although pharmacologic prophylaxis regimens have reduced 
      VTE risk in medically ill patients, associations with early postdischarge adverse 
      clinical outcomes among patients with heart failure are unknown. HYPOTHESIS: We 
      hypothesized that patients receiving pharmacologic VTE prophylaxis during 
      hospitalization for heart failure would have lower rates of postdischarge adverse 
      clinical outcomes than patients not receiving prophylaxis. METHODS: Using data 
      from the Acute Decompensated Heart Failure (ADHERE) registry linked to Medicare 
      claims, we estimated 30-day postdischarge outcome rates for patients who received 
      in-hospital subcutaneous heparin compared with patients who did not receive 
      in-hospital VTE prophylaxis. We excluded patients who received warfarin or 
      intravenous heparin. Outcomes included mortality, thromboembolic events, major 
      adverse cardiovascular events, and all-cause readmission. We used 
      propensity-score methods to estimate associations between VTE prophylaxis and 
      each outcome. In a secondary analysis, we compared outcomes of patients receiving 
      pharmacologic prophylaxis with unfractionated heparin (UFH) vs 
      low-molecular-weight heparin (LMWH). RESULTS: Of 36 799 eligible patients in 265 
      hospitals, 12 169 (33%) received pharmacologic VTE prophylaxis during the 
      hospitalization. In unadjusted analysis and after weighting by the inverse 
      probability of treatment, VTE prophylaxis was not associated with 30-day 
      postdischarge mortality, thromboembolic events, major adverse cardiovascular 
      events, or all-cause readmission. There were no differences in outcomes between 
      patients receiving UFH and those receiving LMWH. CONCLUSIONS: Pharmacologic VTE 
      prophylaxis is provided to one-third of older patients hospitalized with heart 
      failure. Treatment with LMWH or UFH did not have a statistically significant 
      association with 30-day postdischarge outcomes.
CI  - (c) 2011 Wiley Periodicals, Inc.
FAU - Kociol, Robb D
AU  - Kociol RD
AD  - Duke Clinical Research Institute, Department of Medicine, Duke University School 
      of Medicine, Durham, North Carolina, USA. rkociol@tuftsmedicalcenter.org
FAU - Hammill, Bradley G
AU  - Hammill BG
FAU - Hernandez, Adrian F
AU  - Hernandez AF
FAU - Klaskala, Winslow
AU  - Klaskala W
FAU - Mills, Roger M
AU  - Mills RM
FAU - Curtis, Lesley H
AU  - Curtis LH
FAU - Fonarow, Gregg C
AU  - Fonarow GC
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20111106
PL  - United States
TA  - Clin Cardiol
JT  - Clinical cardiology
JID - 7903272
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*administration & dosage
MH  - Chi-Square Distribution
MH  - Female
MH  - Heart Failure/complications/*therapy
MH  - Heparin/*administration & dosage
MH  - Heparin, Low-Molecular-Weight/administration & dosage
MH  - *Hospitalization
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Logistic Models
MH  - Male
MH  - *Medicare Part A
MH  - Patient Discharge
MH  - Patient Readmission
MH  - Propensity Score
MH  - Proportional Hazards Models
MH  - Registries
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - United States
MH  - Venous Thromboembolism/etiology/*prevention & control
PMC - PMC6652431
EDAT- 2011/11/08 06:00
MHDA- 2012/03/13 06:00
PMCR- 2011/11/06
CRDT- 2011/11/08 06:00
PHST- 2011/05/19 00:00 [received]
PHST- 2011/09/01 00:00 [accepted]
PHST- 2011/11/08 06:00 [entrez]
PHST- 2011/11/08 06:00 [pubmed]
PHST- 2012/03/13 06:00 [medline]
PHST- 2011/11/06 00:00 [pmc-release]
AID - CLC20986 [pii]
AID - 10.1002/clc.20986 [doi]
PST - ppublish
SO  - Clin Cardiol. 2011 Nov;34(11):682-8. doi: 10.1002/clc.20986. Epub 2011 Nov 6.