PMID- 30347498 OWN - NLM STAT- MEDLINE DCOM- 20191107 LR - 20230829 IS - 1538-7836 (Electronic) IS - 1538-7836 (Linking) VI - 16 IP - 12 DP - 2018 Dec TI - Evaluation of unfractionated heparin versus low-molecular-weight heparin and fondaparinux for pharmacologic venous thromboembolic prophylaxis in critically ill patients with cancer. PG - 2492-2500 LID - 10.1111/jth.14317 [doi] AB - Essentials Critically ill cancer patients require pharmacologic prophylaxis for venous thromboembolism (VTE). Patients from 566 hospitals in the United States between 2010 and 2014 were included. Low-molecular-weight heparin (LMWH) prophylaxis was not associated in a reduction of VTE rates. LMWH prophylaxis was associated with a reduction in bleeding and heparin induced thrombocytopenia. SUMMARY: Background Critically ill patients with cancer are at increased risk of venous thromboembolism (VTE) from physical and cellular factors, requiring pharmacologic prophylaxis to reduce the risk of VTE. Objectives To assess whether low-molecular-weight heparin (LMWH) prophylaxis reduces in-hospital rates of VTE or improves clinical outcomes compared with unfractionated heparin (UFH) prophylaxis in critically ill patients with cancer. Methods We used a propensity-matched comparative-effectiveness cohort from the Premier Database. Patients aged 18 years or older with a primary diagnosis of cancer, intensive care unit admission and VTE prophylaxis within 2 days of admission between 1 January 2010 and 31 December 2014 were included. Patients were divided into LMWH or UFH prophylaxis groups. Results A total of 103 798 patients were included; 75 321 (72.6%) patients received LMWH and 28 477 (27.4%) patients received UFH. Propensity analysis matched (2 : 1) 42 343 LMWH patients and 21 218 UFH patients. Overall, LMWH was not associated with a decreased incidence of VTE (5.32% vs. 5.50%). LMWH prophylaxis was associated with a reduction in pulmonary embolism (0.70% vs. 0.99%), significant bleeding (13.3% vs. 14.8%) and heparin-induced thrombocytopenia (HIT) (0.06% vs. 0.19%). In non-metastatic solid disease, LMWH was associated with decreased VTE (4.27% vs. 4.84%) and PE (0.47% vs. 0.95%). Conclusions The use of an LMWH for VTE prophylaxis was not associated with a reduction in the incidence of in-hospital VTE as compared with UFH, but was associated with significant reductions in PE, clinically important bleeding events, and incidence of HIT in critically ill patients with cancer. CI - (c) 2018 International Society on Thrombosis and Haemostasis. FAU - Van Matre, E T AU - Van Matre ET AUID- ORCID: 0000-0001-9125-9509 AD - Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA. FAU - Reynolds, P M AU - Reynolds PM AD - Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA. FAU - MacLaren, R AU - MacLaren R AD - Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA. FAU - Mueller, S W AU - Mueller SW AD - Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA. FAU - Wright, G C AU - Wright GC AD - Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA. FAU - Moss, M AU - Moss M AD - Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. FAU - Burnham, E L AU - Burnham EL AD - Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. FAU - Ho, P M AU - Ho PM AD - Colorado Pulmonary Outcomes Research Group (CPOR), University of Colorado, Anschutz Medical Campus, Aurora. AD - Division of Cardiology, Department of Medicine, VA Eastern Colorado Health Care System, Denver, CO, USA. FAU - Vandivier, R W AU - Vandivier RW AD - Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA. FAU - Kiser, T H AU - Kiser TH AUID- ORCID: 0000-0001-7415-3999 AD - Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA. LA - eng PT - Comparative Study PT - Journal Article PT - Multicenter Study DEP - 20181115 PL - England TA - J Thromb Haemost JT - Journal of thrombosis and haemostasis : JTH JID - 101170508 RN - 0 (Anticoagulants) RN - 0 (Factor Xa Inhibitors) RN - 0 (Heparin, Low-Molecular-Weight) RN - J177FOW5JL (Fondaparinux) SB - IM MH - Adolescent MH - Adult MH - Aged MH - Aged, 80 and over MH - Anticoagulants/adverse effects/*therapeutic use MH - Comparative Effectiveness Research MH - Critical Illness MH - Databases, Factual MH - Factor Xa Inhibitors/adverse effects/*therapeutic use MH - Female MH - Fondaparinux/adverse effects/*therapeutic use MH - Hemorrhage/chemically induced MH - Heparin, Low-Molecular-Weight/adverse effects/*therapeutic use MH - Humans MH - Male MH - Middle Aged MH - Neoplasms/blood/complications/*drug therapy MH - Risk Factors MH - Thrombocytopenia/chemically induced MH - Time Factors MH - Treatment Outcome MH - United States MH - Venous Thromboembolism/blood/etiology/*prevention & control MH - Young Adult OTO - NOTNLM OT - critical illness OT - heparin, low-molecular-weight OT - heparin, unfractionated OT - neoplasms OT - prophylaxis OT - venous thromboembolism EDAT- 2018/10/23 06:00 MHDA- 2019/11/08 06:00 CRDT- 2018/10/23 06:00 PHST- 2018/07/17 00:00 [received] PHST- 2018/10/23 06:00 [pubmed] PHST- 2019/11/08 06:00 [medline] PHST- 2018/10/23 06:00 [entrez] AID - S1538-7836(22)02958-0 [pii] AID - 10.1111/jth.14317 [doi] PST - ppublish SO - J Thromb Haemost. 2018 Dec;16(12):2492-2500. doi: 10.1111/jth.14317. Epub 2018 Nov 15.