PMID- 37396589
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230704
IS  - 2297-055X (Print)
IS  - 2297-055X (Electronic)
IS  - 2297-055X (Linking)
VI  - 10
DP  - 2023
TI  - Effectiveness, safety, and costs of thromboprophylaxis with enoxaparin or 
      unfractionated heparin in inpatients with obesity.
PG  - 1163684
LID - 10.3389/fcvm.2023.1163684 [doi]
LID - 1163684
AB  - BACKGROUND: Obesity is a frequent and significant risk factor for venous 
      thromboembolism (VTE) among hospitalized adults. Pharmacologic thromboprophylaxis 
      can help prevent VTE, but real-world effectiveness, safety, and costs among 
      inpatients with obesity are unknown. OBJECTIVE: This study aims to compare 
      clinical and economic outcomes among adult medical inpatients with obesity who 
      received thromboprophylaxis with enoxaparin or unfractionated heparin (UFH). 
      METHODS: A retrospective cohort study was performed using the PINC AI Healthcare 
      Database, which covers more than 850 hospitals in the United States. Patients 
      included were >/=18 years old, had a primary or secondary discharge diagnosis of 
      obesity [International Classification of Diseases (ICD)-9 diagnosis codes 278.01, 
      278.02, and 278.03; ICD-10 diagnosis codes E66.0x, E66.1, E66.2, E66.8, and 
      E66.9], received >/=1 thromboprophylactic dose of enoxaparin (</=40 mg/day) or UFH 
      (</=15,000 IU/day) during the index hospitalization, stayed >/=6 days in the 
      hospital, and were discharged between 01 January 2010, and 30 September 2016. We 
      excluded surgical patients, patients with pre-existing VTE, and those who 
      received higher (treatment-level) doses or multiple types of anticoagulants. 
      Multivariable regression models were constructed to compare enoxaparin with UFH 
      based on the incidence of VTE, pulmonary embolism (PE)---------related mortality, 
      overall in-hospital mortality, major bleeding, treatment costs, and total 
      hospitalization costs during the index hospitalization and the 90 days after 
      index discharge (readmission period). RESULTS: Among 67,193 inpatients who met 
      the selection criteria, 44,367 (66%) and 22,826 (34%) received enoxaparin and 
      UFH, respectively, during their index hospitalization. Demographic, 
      visit-related, clinical, and hospital characteristics differed significantly 
      between groups. Enoxaparin during index hospitalization was associated with 29%, 
      73%, 30%, and 39% decreases in the adjusted odds of VTE, PE-related mortality, 
      in-hospital mortality, and major bleeding, respectively, compared with UFH (all 
      p < 0.002). Compared with UFH, enoxaparin was associated with significantly lower 
      total hospitalization costs during the index hospitalization and readmission 
      periods. CONCLUSIONS: Among adult inpatients with obesity, primary 
      thromboprophylaxis with enoxaparin compared with UFH was associated with 
      significantly lower risks of in-hospital VTE, major bleeding, PE-related 
      mortality, overall in-hospital mortality, and hospitalization costs.
CI  - (c) 2023 Amin, Kartashov, Ngai, Steele and Rosenthal.
FAU - Amin, Alpesh
AU  - Amin A
AD  - Department of Medicine, University of California at Irvine, Irvine, CA, United 
      States.
FAU - Kartashov, Alex
AU  - Kartashov A
AD  - PINC AI Applied Sciences, Premier Inc., Charlotte, NC, United States.
FAU - Ngai, Wilson
AU  - Ngai W
AD  - Sanofi, Bridgewater, NJ, United States.
FAU - Steele, Kevin
AU  - Steele K
AD  - Sanofi, Bridgewater, NJ, United States.
FAU - Rosenthal, Ning
AU  - Rosenthal N
AD  - PINC AI Applied Sciences, Premier Inc., Charlotte, NC, United States.
LA  - eng
PT  - Journal Article
DEP - 20230616
PL  - Switzerland
TA  - Front Cardiovasc Med
JT  - Frontiers in cardiovascular medicine
JID - 101653388
PMC - PMC10313352
OTO - NOTNLM
OT  - bleeding
OT  - cost analyses
OT  - enoxaparin
OT  - medical inpatients
OT  - obesity
OT  - thromboprophylaxis
OT  - unfractionated heparin
OT  - venous thromboembolism (VTE)
COIS- AK and NR are employees and shareholders of Premier Inc. KS and WN are employees 
      and shareholders of Sanofi. AA has been a principal investigator or 
      co-investigator of clinical trials sponsored by NIH/NIAID, NeuroRx Pharma, 
      Pulmotect, Blade Therapeutics, Novartis, Takeda, Humanigen, Eli Lilly, PTC 
      Therapeutics, Octapharma, Fulcrum Therapeutics, Alexion and has been a speaker 
      and/or consultant for BMS, Pfizer, BI, Portola, Sunovion, Mylan, Salix, Alexion, 
      AstraZeneca, Novartis, Nabriva, Paratek, Bayer, Tetraphase, Achaogen, La Jolla, 
      Ferring, Seres, Spero, Eli Lilly, Gilead, Millenium, HeartRite, Aseptiscope, and 
      Sprightly; these relationships were unrelated to the current work.
EDAT- 2023/07/03 13:05
MHDA- 2023/07/03 13:06
PMCR- 2023/01/01
CRDT- 2023/07/03 11:22
PHST- 2023/02/11 00:00 [received]
PHST- 2023/05/08 00:00 [accepted]
PHST- 2023/07/03 13:06 [medline]
PHST- 2023/07/03 13:05 [pubmed]
PHST- 2023/07/03 11:22 [entrez]
PHST- 2023/01/01 00:00 [pmc-release]
AID - 10.3389/fcvm.2023.1163684 [doi]
PST - epublish
SO  - Front Cardiovasc Med. 2023 Jun 16;10:1163684. doi: 10.3389/fcvm.2023.1163684. 
      eCollection 2023.