PMID- 33313988
OWN - NLM
STAT- MEDLINE
DCOM- 20211203
LR  - 20211214
IS  - 1179-187X (Electronic)
IS  - 1175-3277 (Print)
IS  - 1175-3277 (Linking)
VI  - 21
IP  - 4
DP  - 2021 Jul
TI  - Real-World Comparative Effectiveness and Cost Comparison of Thromboprophylactic 
      Use of Enoxaparin versus Unfractionated Heparin in 376,858 Medically Ill 
      Hospitalized US Patients.
PG  - 443-452
LID - 10.1007/s40256-020-00456-4 [doi]
AB  - BACKGROUND: Venous thromboembolism (VTE) is a serious complication in medically 
      ill inpatients. Enoxaparin or unfractionated heparin (UFH) thromboprophylaxis has 
      been shown to reduce VTE in clinical trials; however, comparative effectiveness 
      and differences in hospital costs are unknown in US hospital practice. OBJECTIVE: 
      This study compared clinical and economic outcomes between enoxaparin and UFH 
      thromboprophylaxis in medically ill inpatients. METHODS: A retrospective cohort 
      study was conducted using the Premier Healthcare Database between 1 January 2010 
      and 30 September 2016. Inpatients aged >/= 18 years with a >/= 6-day hospital stay 
      for serious medical conditions were included. Two patient groups receiving 
      thromboprophylaxis were identified during hospitalization: one receiving 
      enoxaparin and other receiving UFH. Regression models were constructed to compare 
      VTE events, in-hospital mortality, pulmonary embolism (PE)-related mortality, 
      major bleeding, and total hospital costs during both the index hospitalization 
      and the 90-day readmission period between the two groups. RESULTS: A total of 
      242,474 and 134,384 inpatients received enoxaparin or UFH for thromboprophylaxis, 
      respectively. Compared with UFH prophylaxis, enoxaparin was significantly 
      associated with 15%, 9%, 33%, and 41% reduced odds of VTE, in-hospital mortality, 
      PE-related mortality, and major bleeding, respectively, during index 
      hospitalization, and 10% and 19% reduced odds of VTE and bleeding, respectively, 
      during the readmission period. Mean total hospital costs were significantly lower 
      in patients receiving enoxaparin prophylaxis than in those given UFH. 
      CONCLUSIONS: Thromboprophylaxis with enoxaparin was associated with significantly 
      reduced in-hospital VTE events, death, and major bleeding and lower hospital 
      costs compared with UFH in hospitalized medically ill patients.
FAU - Veeranki, S Phani
AU  - Veeranki SP
AD  - Premier Applied Sciences, Premier Inc., Charlotte, NC, USA.
AD  - Department of Preventive Medicine and Community Health, University of Texas 
      Medical Branch, Galveston, TX, USA.
AD  - Precision HEOR, 11100 Santa Monica Blvd., Suite 500, Los Angeles, CA, USA.
FAU - Xiao, Zhimin
AU  - Xiao Z
AD  - Sanofi, Cambridge, MA, USA.
AD  - , 650 E Kendall St, Cambridge, MA, 02138, USA.
FAU - Levorsen, Andree
AU  - Levorsen A
AUID- ORCID: 0000-0001-5038-029X
AD  - Global Health Economics and Value Assessment, Sanofi, Professor Kohtsvei 5-17, 
      Lysaker, 1366, Oslo, Norway. andree.levorsen@sanofi.com.
FAU - Sinha, Meenal
AU  - Sinha M
AD  - Premier Applied Sciences, Premier Inc., Charlotte, NC, USA.
FAU - Shah, Bimal R
AU  - Shah BR
AD  - Livongo Health, Mountain View, CA, USA.
AD  - Department of Medicine, Duke University, Durham, NC, USA.
LA  - eng
PT  - Journal Article
DEP - 20201214
PL  - New Zealand
TA  - Am J Cardiovasc Drugs
JT  - American journal of cardiovascular drugs : drugs, devices, and other 
      interventions
JID - 100967755
RN  - 0 (Anticoagulants)
RN  - 0 (Enoxaparin)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*administration & dosage/economics
MH  - Costs and Cost Analysis
MH  - Enoxaparin/*administration & dosage/economics
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Heparin/*administration & dosage/economics
MH  - Hospital Mortality
MH  - Hospitalization/statistics & numerical data
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Sex Factors
MH  - Socioeconomic Factors
MH  - United States
MH  - Venous Thromboembolism/*prevention & control
PMC - PMC8263404
COIS- S.P. Veeranki was an employee of Premier Applied Sciences, Premier Inc. at the 
      time of the study. M. Sinha is an employee of Premier Applied Sciences, Premier, 
      Inc. Premier Applied Sciences received funding from Sanofi US Services, Inc. to 
      conduct this study. B. Shah is employed by and holds equity from Livongo Health 
      and also serves as a consultant for Premier Inc., Janssen, and Medtronic. Z. Xiao 
      was an employee of Sanofi at the time of the study and is a stockholder. A. 
      Levorsen is an employee of and stockholder in Sanofi.
EDAT- 2020/12/15 06:00
MHDA- 2021/12/15 06:00
PMCR- 2020/12/14
CRDT- 2020/12/14 11:04
PHST- 2020/11/13 00:00 [accepted]
PHST- 2020/12/15 06:00 [pubmed]
PHST- 2021/12/15 06:00 [medline]
PHST- 2020/12/14 11:04 [entrez]
PHST- 2020/12/14 00:00 [pmc-release]
AID - 10.1007/s40256-020-00456-4 [pii]
AID - 456 [pii]
AID - 10.1007/s40256-020-00456-4 [doi]
PST - ppublish
SO  - Am J Cardiovasc Drugs. 2021 Jul;21(4):443-452. doi: 10.1007/s40256-020-00456-4. 
      Epub 2020 Dec 14.