PMID- 33901051
OWN - NLM
STAT- MEDLINE
DCOM- 20210924
LR  - 20230825
IS  - 2163-0763 (Electronic)
IS  - 2163-0755 (Linking)
VI  - 91
IP  - 3
DP  - 2021 Sep 1
TI  - A tale of two centers: Is low-molecular-weight heparin really superior for 
      prevention of posttraumatic venous thromboembolism?
PG  - 537-541
LID - 10.1097/TA.0000000000003257 [doi]
AB  - BACKGROUND: Low-molecular-weight heparin (LMWH) is widely used for venous 
      thromboembolism chemoprophylaxis following injury. However, unfractionated 
      heparin (UFH) is a less expensive option. We compared LMWH and UFH for prevention 
      of posttraumatic deep venous thrombosis (DVT) and pulmonary embolism (PE). 
      METHODS: Trauma patients 15 years or older with at least one administration of 
      venous thromboembolism chemoprophylaxis at two level I trauma centers with 
      similar DVT-screening protocols were identified. Center 1 administered UFH every 
      8 hours for chemoprophylaxis, and center 2 used twice-daily antifactor 
      Xa-adjusted LMWH. Clinical characteristics and primary chemoprophylaxis agent 
      were evaluated in a two-level logistic regression model. Primary outcome was 
      incidence of DVT and PE. RESULTS: There were 3,654 patients: 1,155 at center 1 
      and 2,499 at center 2. The unadjusted DVT rate at center 1 was lower than at 
      center 2 (3.5% vs. 5.0%; p = 0.04); PE rates did not significantly differ (0.4% 
      vs. 0.6%; p = 0.64). Patients at center 2 were older (mean, 50.3 vs. 47.3 years; 
      p < 0.001) and had higher Injury Severity Scores (median, 10 vs. 9; p < 0.001), 
      longer stays in the hospital (mean, 9.4 vs. 7.0 days; p < 0.001) and intensive 
      care unit (mean, 3.0 vs. 1.3 days; p < 0.001), and a higher mortality rate (1.6% 
      vs. 0.6%, p = 0.02) than patients at center 1. Center 1's patients received their 
      first dose of chemoprophylaxis earlier than patients at center 2 (median, 1.0 vs. 
      1.7 days; p < 0.001). After risk adjustment and accounting for center effects, 
      primary chemoprophylaxis agent was not associated with risk of DVT (odds ratio, 
      1.01; 95% confidence interval, 0.69-1.48; p = 0.949). Cost calculations showed 
      that UFH was less expensive than LMWH. CONCLUSION: Primary utilization of UFH is 
      not inferior to LMWH for posttraumatic DVT chemoprophylaxis and rates of PE are 
      similar. Given that UFH is lower in cost, the choice of this chemoprophylaxis 
      agent may have major economic implications. LEVEL OF EVIDENCE: Prognostic and 
      epidemiological, level II; Therapeutic, level III.
CI  - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Checchi, Kyle D
AU  - Checchi KD
AD  - From the Trauma Service, Department of Surgery (K.D.C., J.B., R.Y.C., A.S.R., 
      L.E.W., J.M.P., C.B.S., M.J.S., M.J.M., V.B.), Scripps Mercy Hospital; Division 
      of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of 
      Surgery (T.W.C., A.E.B.), University of California San Diego, San Diego, 
      California.
FAU - Costantini, Todd W
AU  - Costantini TW
FAU - Badiee, Jayraan
AU  - Badiee J
FAU - Berndtson, Allison E
AU  - Berndtson AE
FAU - Calvo, Richard Y
AU  - Calvo RY
FAU - Rooney, Alexandra S
AU  - Rooney AS
FAU - Wessels, Lyndsey E
AU  - Wessels LE
FAU - Prieto, James M
AU  - Prieto JM
FAU - Sise, C Beth
AU  - Sise CB
FAU - Sise, Michael J
AU  - Sise MJ
FAU - Martin, Matthew J
AU  - Martin MJ
FAU - Bansal, Vishal
AU  - Bansal V
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - J Trauma Acute Care Surg
JT  - The journal of trauma and acute care surgery
JID - 101570622
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anticoagulants/economics/*therapeutic use
MH  - California/epidemiology
MH  - Female
MH  - Heparin/economics/*therapeutic use
MH  - Heparin, Low-Molecular-Weight/economics/therapeutic use
MH  - Humans
MH  - Injury Severity Score
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Pulmonary Embolism/epidemiology/*prevention & control
MH  - Trauma Centers
MH  - Venous Thromboembolism/epidemiology/etiology/*prevention & control
MH  - Wounds and Injuries/*complications
EDAT- 2021/04/27 06:00
MHDA- 2021/09/25 06:00
CRDT- 2021/04/26 17:18
PHST- 2021/04/27 06:00 [pubmed]
PHST- 2021/09/25 06:00 [medline]
PHST- 2021/04/26 17:18 [entrez]
AID - 01586154-202109000-00013 [pii]
AID - 10.1097/TA.0000000000003257 [doi]
PST - ppublish
SO  - J Trauma Acute Care Surg. 2021 Sep 1;91(3):537-541. doi: 
      10.1097/TA.0000000000003257.