PMID- 31991331
OWN - NLM
STAT- MEDLINE
DCOM- 20200731
LR  - 20200731
IS  - 1095-8673 (Electronic)
IS  - 0022-4804 (Linking)
VI  - 249
DP  - 2020 May
TI  - Retrospective Evaluation of Venous Thromboembolism Prophylaxis in Elderly, 
      High-Risk Trauma Patients.
PG  - 225-231
LID - S0022-4804(20)30002-0 [pii]
LID - 10.1016/j.jss.2019.12.024 [doi]
AB  - BACKGROUND: Venous thromboembolism (VTE) risk increases with age. Scarce data 
      exist for patients age >/=65 y. This study evaluated VTE incidence in elderly, 
      high-risk trauma patients receiving unfractionated heparin (UFH) or enoxaparin 
      chemoprophylaxis. MATERIALS AND METHODS: This retrospective, single-center, 
      cohort study included trauma patients age >/= 65 y with risk assessment profile 
      (RAP) >/= 5 who received UFH or enoxaparin chemoprophylaxis. The primary outcome 
      was VTE incidence requiring therapeutic anticoagulation. An age-modified RAP 
      (RAP-AM) was calculated as RAP without age distribution points. Logistic 
      regression analyses were performed to identify independent predictors for VTE 
      development and chemoprophylactic agent selection. Bleeding incidence compared 
      packed red blood cells utilized. RESULTS: A total of 1090 patients were included 
      (UFH, n = 655; enoxaparin, n = 435). VTE occurred in 39 (3.6%) patients with no 
      difference between groups in proximal deep vein thrombosis (2.1% versus 3.0%, 
      P = 0.52) or pulmonary embolism (1.2% versus 1.4%, P = 0.96). Weight >/=125 kg (OR 
      4.12, 95% CI 1.06-16.11) and RAP-AM >/= 5 (OR 6.52, 95% CI 2.65-16.03) were 
      independently associated with VTE development. Increasing age (OR 1.04, 95% CI 
      1.03-1.06), initiation </= 24 h (OR 2.17, 95% CI 1.66-2.84) and creatinine 
      clearance </= 30 mL/min (OR 1.61, 95% CI 1.17-2.21) were independent predictors of 
      receiving UFH whereas increasing ISS (OR 0.97, 95% CI 0.95-0.99) was associated 
      with receiving enoxaparin. CONCLUSIONS: VTE incidence may be similar for 
      high-risk, elderly trauma patients receiving UFH and enoxaparin chemoprophylaxis. 
      Further research is necessary to determine noninferiority of UFH to enoxaparin in 
      this patient population.
CI  - Copyright (c) 2020 Elsevier Inc. All rights reserved.
FAU - Krantz, Erica N
AU  - Krantz EN
AD  - UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University 
      of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio. Electronic 
      address: ericakrantz7@gmail.com.
FAU - Philpott, Carolyn D
AU  - Philpott CD
AD  - UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University 
      of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio.
FAU - Droege, Molly E
AU  - Droege ME
AD  - UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University 
      of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio.
FAU - Mueller, Eric W
AU  - Mueller EW
AD  - UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University 
      of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio.
FAU - Ernst, Neil E
AU  - Ernst NE
AD  - UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University 
      of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio.
FAU - Garber, Paige M
AU  - Garber PM
AD  - UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University 
      of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio.
FAU - Tsuei, Betty J
AU  - Tsuei BJ
AD  - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, 
      Ohio.
FAU - Goodman, Michael D
AU  - Goodman MD
AD  - Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, 
      Ohio.
FAU - Droege, Christopher A
AU  - Droege CA
AD  - UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University 
      of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20200125
PL  - United States
TA  - J Surg Res
JT  - The Journal of surgical research
JID - 0376340
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Aging/physiology
MH  - Anticoagulants/*therapeutic use
MH  - Enoxaparin/*therapeutic use
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Pulmonary Embolism/epidemiology/etiology/physiopathology/*prevention & control
MH  - Registries/statistics & numerical data
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Venous Thromboembolism/epidemiology/etiology/physiopathology/*prevention & 
      control
MH  - Wounds and Injuries/*complications
OTO - NOTNLM
OT  - Chemoprophylaxis
OT  - Elderly
OT  - Pharmacology
OT  - Thromboembolism
OT  - Trauma
EDAT- 2020/01/29 06:00
MHDA- 2020/08/01 06:00
CRDT- 2020/01/29 06:00
PHST- 2019/10/02 00:00 [received]
PHST- 2019/11/27 00:00 [revised]
PHST- 2019/12/02 00:00 [accepted]
PHST- 2020/01/29 06:00 [pubmed]
PHST- 2020/08/01 06:00 [medline]
PHST- 2020/01/29 06:00 [entrez]
AID - S0022-4804(20)30002-0 [pii]
AID - 10.1016/j.jss.2019.12.024 [doi]
PST - ppublish
SO  - J Surg Res. 2020 May;249:225-231. doi: 10.1016/j.jss.2019.12.024. Epub 2020 Jan 
      25.