PMID- 22473716
OWN - NLM
STAT- MEDLINE
DCOM- 20121226
LR  - 20220311
IS  - 1553-5606 (Electronic)
IS  - 1553-5592 (Linking)
VI  - 7
IP  - 6
DP  - 2012 Jul-Aug
TI  - Comparative effectiveness of low-molecular-weight heparin versus unfractionated 
      heparin for thromboembolism prophylaxis for medical patients.
PG  - 457-63
LID - 10.1002/jhm.1938 [doi]
AB  - 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.
CI  - Copyright (c) 2012 Society of Hospital Medicine.
FAU - Rothberg, Michael B
AU  - Rothberg MB
AD  - Center for Quality of Care Research, Baystate Medical Center, Springfield, 
      Massachusetts 01199, USA. michael.rothberg@bhs.org
FAU - Pekow, Penelope S
AU  - Pekow PS
FAU - Lahti, Maureen
AU  - Lahti M
FAU - Lindenauer, Peter K
AU  - Lindenauer PK
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120402
PL  - United States
TA  - J Hosp Med
JT  - Journal of hospital medicine
JID - 101271025
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Heparin/administration & dosage/adverse effects/therapeutic use
MH  - Heparin, Low-Molecular-Weight/administration & dosage/adverse 
      effects/*therapeutic use
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - United States
MH  - Venous Thromboembolism/drug therapy/*prevention & control
MH  - Young Adult
EDAT- 2012/04/05 06:00
MHDA- 2012/12/27 06:00
CRDT- 2012/04/05 06:00
PHST- 2011/11/07 00:00 [received]
PHST- 2012/01/31 00:00 [revised]
PHST- 2012/02/01 00:00 [accepted]
PHST- 2012/04/05 06:00 [entrez]
PHST- 2012/04/05 06:00 [pubmed]
PHST- 2012/12/27 06:00 [medline]
AID - 10.1002/jhm.1938 [doi]
PST - ppublish
SO  - J Hosp Med. 2012 Jul-Aug;7(6):457-63. doi: 10.1002/jhm.1938. Epub 2012 Apr 2.