PMID- 38390025
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240326
IS  - 2327-2236 (Electronic)
IS  - 2326-697X (Print)
IS  - 2326-697X (Linking)
VI  - 11
IP  - 1
DP  - 2024
TI  - Effectiveness, Safety, and Costs of Thromboprophylaxis with Enoxaparin or 
      Unfractionated Heparin Among Medical Inpatients With Chronic Obstructive 
      Pulmonary Disease or Heart Failure.
PG  - 44-56
LID - 10.36469/001c.92408 [doi]
AB  - Background: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) 
      are risk factors for venous thromboembolism (VTE). Enoxaparin and unfractionated 
      heparin (UFH) help prevent hospital-associated VTE, but few studies have compared 
      them in COPD or HF. Objectives: To compare effectiveness, safety, and costs of 
      enoxaparin vs UFH thromboprophylaxis in medical inpatients with COPD or HF. 
      Methods: This retrospective cohort study included adults with COPD or HF from the 
      Premier PINC AI Healthcare Database. Included patients received prophylactic-dose 
      enoxaparin or UFH during a >6-day index hospitalization (the first 
      visit/admission that met selection criteria during the study period) between 
      January 1, 2010, and September 30, 2016. Multivariable regression models assessed 
      independent associations between exposures and outcomes. Hospital costs were 
      adjusted to 2017 US dollars. Patients were followed 90 days postdischarge 
      (readmission period). Results: In the COPD cohort, 114 174 (69%) patients 
      received enoxaparin and 51 011 (31%) received UFH. Among patients with COPD, 
      enoxaparin recipients had 21%, 37%, and 10% lower odds of VTE, major bleeding, 
      and in-hospital mortality during index admission, and 17% and 50% lower odds of 
      major bleeding and heparin-induced thrombocytopenia (HIT) during the readmission 
      period, compared with UFH recipients (all P <.006). In the HF cohort, 58 488 
      (58%) patients received enoxaparin and 42 726 (42%) received UFH. Enoxaparin 
      recipients had 24% and 10% lower odds of major bleeding and in-hospital mortality 
      during index admission, and 13%, 11%, and 51% lower odds of VTE, major bleeding, 
      and HIT during readmission (all P <.04) compared with UFH recipients. Enoxaparin 
      recipients also had significantly lower total hospital costs during index 
      admission (mean reduction per patient: COPD, 1280; HF, 2677) and readmission 
      (COPD, 379; HF, 1024). Among inpatients with COPD or HF, thromboprophylaxis with 
      enoxaparin vs UFH was associated with significantly lower odds of bleeding, 
      mortality, and HIT, and with lower hospital costs. Conclusions: This study 
      suggests that thromboprophylaxis with enoxaparin is associated with better 
      outcomes and lower costs among medical inpatients with COPD or HF based on 
      real-world evidence. Our findings underscore the importance of assessing clinical 
      outcomes and side effects when evaluating cost-effectiveness.
FAU - Amin, Alpesh N
AU  - Amin AN
AD  - Department of Medicine University of California, Irvine. ROR: 
      https://ror.org/04gyf1771
FAU - Kartashov, Alex
AU  - Kartashov A
AD  - PINC AI Applied Sciences, Premier Inc., Charlotte, North Carolina, USA.
FAU - Ngai, Wilson
AU  - Ngai W
AD  - Sanofi, Bridgewater, New Jersey, USA.
FAU - Steele, Kevin
AU  - Steele K
AD  - Sanofi, Bridgewater, New Jersey, USA.
FAU - Rosenthal, Ning
AU  - Rosenthal N
AD  - PINC AI Applied Sciences, Premier Inc., Charlotte, North Carolina, USA.
LA  - eng
PT  - Journal Article
DEP - 20240220
PL  - United States
TA  - J Health Econ Outcomes Res
JT  - Journal of health economics and outcomes research
JID - 101648581
PMC - PMC10883471
OTO - NOTNLM
OT  - bleeding
OT  - chronic heart failure
OT  - chronic obstructive pulmonary disease
OT  - cost analysis
OT  - enoxaparin
OT  - heparin
OT  - medical inpatients
OT  - thromboprophylaxis
COIS- A.K. and N.R. are employees and shareholders of Premier Inc. K.S. and W.N. are 
      employees and shareholders of Sanofi. A.A. 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, and Alexion, and a speaker and/or 
      consultant for Pfizer, Salix, Alexion, AstraZeneca, Bayer, Ferring, Seres, Spero, 
      Eli Lilly, Nova Nordisk, Gilead, Renibus, GSK, Dexcom, HeartRite, and 
      Aseptiscope; these relationships are unrelated to the current work.
EDAT- 2024/02/23 06:43
MHDA- 2024/02/23 06:44
PMCR- 2024/02/20
CRDT- 2024/02/23 03:51
PHST- 2023/11/24 00:00 [received]
PHST- 2024/01/12 00:00 [accepted]
PHST- 2024/02/23 06:44 [medline]
PHST- 2024/02/23 06:43 [pubmed]
PHST- 2024/02/23 03:51 [entrez]
PHST- 2024/02/20 00:00 [pmc-release]
AID - 92408 [pii]
AID - 10.36469/001c.92408 [doi]
PST - epublish
SO  - J Health Econ Outcomes Res. 2024 Feb 20;11(1):44-56. doi: 10.36469/001c.92408. 
      eCollection 2024.