Unfractionated Heparin Versus Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Trauma.

Background: Venous thromboembolism (VTE) is a common complication in trauma patients. Pharmacologic prophylaxis is utilized in trauma patients to reduce their risk of a VTE event. The Eastern Association for the Surgery of Trauma guidelines recommend use of low molecular weight heparin (LMWH) as the preferred agent in these patients. However, there is literature suggesting that unfractionated heparin (UFH) is an acceptable, and less costly, alternative VTE prophylaxis agent with equivalent efficacy in trauma patients. We examined data from the Michigan Trauma Quality Improvement Program (MTQIP) to perform a comparative effectiveness study of UFH versus LMWH on outcomes for trauma patients. Methods: We conducted an analysis of MTQIP data from January 2012 to December 2014. The data set contains information on date, time, and drug type of the first dose of VTE prophylaxis. 37,868 patients from 23 hospitals were present with an Injury Severity Score >= 5 and hospitalization > 24 hrs. Patients were excluded if they died within 24 hours, received no pharmacologic VTE prophylaxis, or agents other than UFH or LMWH while admitted to the hospital. We compared patients receiving LMWH to UFH. Outcomes assessed were VTE event, Pulmonary Embolism (PE), Deep Vein Thrombosis (DVT), and mortality during hospitalization. We used a generalized estimating equations approach to fit population-averaged logistic regression models with type of first dose of VTE prophylaxis as the independent variable. UFH was considered the reference value. Timing of the first dose of VTE prophylaxis was entered into the model in addition to standard covariates. Odds ratios were generated for each of the dependent variables of interest. Results: The analysis cohort consisted of 18,010 patients. Patients administered LMWH had a decreased risk of mortality (Odds ratio 0.64, Confidence interval 0.49-0.83), VTE (Odds ratio 0.67, Confidence interval 0.53-0.84), PE (Odds ratio 0.53, Confidence interval 0.35-0.79), and DVT (Odds ratio 0.73, Confidence interval 0.57-0.95) when compared to UFH following risk-adjustment and accounting for hospital effect. The reduced risk of a VTE event for patients receiving LMWH was most pronounced for patients in the lower injury severity categories. Conclusions: In our examination of VTE prophylaxis drug effectiveness, LMWH was found to be superior to UFH in reducing the incidence of mortality and VTE events among trauma patients. Therefore, LMWH should be the preferred VTE prophylaxis agent for use in hospitalized trauma patients. Level of Evidence: Level II, Economic/Decision (C) 2017 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/2pIyitS