PMID- 28823757 OWN - NLM STAT- MEDLINE DCOM- 20190617 LR - 20240313 IS - 1931-3543 (Electronic) IS - 0012-3692 (Print) IS - 0012-3692 (Linking) VI - 153 IP - 1 DP - 2018 Jan TI - Comparative Effectiveness of Enoxaparin vs Dalteparin for Thromboprophylaxis After Traumatic Injury. PG - 133-142 LID - S0012-3692(17)31407-1 [pii] LID - 10.1016/j.chest.2017.08.008 [doi] AB - BACKGROUND: Enoxaparin 30 mg twice daily and dalteparin 5,000 units once daily are two common low-molecular-weight heparin (LMWH) thromboprophylaxis regimens used in the trauma population. Pharmacodynamic studies suggest that enoxaparin provides more potent anticoagulation than does dalteparin. METHODS: In 2009, our institution switched its formulary LMWH from enoxaparin to dalteparin followed by a switch back to enoxaparin in 2013. Using a difference in differences design, we contrasted the change in the VTE rate accompanying the LMWH switch with the change in a control group of trauma patients given unfractionated heparin (UFH) during the same period. RESULTS: The study included 5,880 patients: enoxaparin period (enoxaparin, n = 2,371; UFH, n = 1,539) vs the dalteparin period (dalteparin, n = 1,046; UFH, n = 924). The VTE rate was unchanged in the LMWH group: 3.3/1000 days in the enoxaparin period vs 3.8/1000 days in the dalteparin period: rate ratio (RR), 1.16; 95% CI 0.74-1.81. The rate was also unchanged in the UFH control subjects: 5.7/1,000 days in the enoxaparin period vs 5.2/1,000 days in the dalteparin period: RR, 0.92; 95% CI, 0.61-1.38. After confounding adjustment, the ratio of the change in VTE rate between the LMWH and UFH groups was similar: RR, 1.06; 95% CI 0.71-2.00. A secondary analysis excluding patients with delayed or interrupted prophylaxis (or both) altered this estimate nonsignificantly in favor of enoxaparin: RR, 2.39; 95% CI, 0.80-7.09. CONCLUSIONS: Our results suggest that dalteparin has an effectiveness similar to that of enoxaparin in real-world trauma patients. Future research should investigate how the timing and consistency of prophylaxis affects LMWH effectiveness. CI - Copyright (c) 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved. FAU - Miano, Todd A AU - Miano TA AD - Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA. Electronic address: tmiano81@gmail.com. FAU - Cuker, Adam AU - Cuker A AD - Department of Medicine, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA. FAU - Christie, Jason D AU - Christie JD AD - Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA; Pulmonary, Allergy, and Critical Care Division, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA. FAU - Martin, Niels AU - Martin N AD - Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA. FAU - Smith, Brian AU - Smith B AD - Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA. FAU - Makley, Amy T AU - Makley AT AD - Department of Surgery, the University of Cincinnati College of Medicine, Cincinnati, OH. FAU - Guo, Wensheng AU - Guo W AD - Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA. FAU - Hennessy, Sean AU - Hennessy S AD - Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA. LA - eng GR - R01 HL087115/HL/NHLBI NIH HHS/United States GR - R01 AG025152/AG/NIA NIH HHS/United States GR - K24 HL115354/HL/NHLBI NIH HHS/United States GR - F32 HL124914/HL/NHLBI NIH HHS/United States GR - T32 GM075766/GM/NIGMS NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20170818 PL - United States TA - Chest JT - Chest JID - 0231335 RN - 0 (Enoxaparin) RN - 0 (Fibrinolytic Agents) RN - S79O08V79F (Dalteparin) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Case-Control Studies MH - Comparative Effectiveness Research MH - Dalteparin/*administration & dosage MH - Drug Administration Schedule MH - Drug Substitution MH - Enoxaparin/*administration & dosage MH - Fibrinolytic Agents/*administration & dosage MH - Humans MH - Middle Aged MH - Trauma Centers MH - Treatment Outcome MH - Venous Thromboembolism/*prevention & control MH - Wounds and Injuries/*therapy MH - Young Adult PMC - PMC5812768 OTO - NOTNLM OT - VTE OT - comparative effectiveness OT - dalteparin OT - enoxaparin OT - prophylaxis OT - trauma EDAT- 2017/08/22 06:00 MHDA- 2019/06/18 06:00 PMCR- 2019/01/01 CRDT- 2017/08/22 06:00 PHST- 2017/06/08 00:00 [received] PHST- 2017/07/10 00:00 [revised] PHST- 2017/08/01 00:00 [accepted] PHST- 2017/08/22 06:00 [pubmed] PHST- 2019/06/18 06:00 [medline] PHST- 2017/08/22 06:00 [entrez] PHST- 2019/01/01 00:00 [pmc-release] AID - S0012-3692(17)31407-1 [pii] AID - 10.1016/j.chest.2017.08.008 [doi] PST - ppublish SO - Chest. 2018 Jan;153(1):133-142. doi: 10.1016/j.chest.2017.08.008. Epub 2017 Aug 18.