Retrospective database analysis of the prevention of venous thromboembolism with low-molecular-weight heparin in acutely III medical inpatients in community practice

Lisa J McGarry, David Thompson
Clinical Therapeutics 2004, 26 (3): 419-30

BACKGROUND: Clinical trials have demonstrated that prophylaxis with low-molecular-weight heparin reduces the occurrence of venous thromboembolism (VTE) among acutely ill medical inpatients in the experimental setting.

OBJECTIVE: The goal of this retrospective database analysis was to examine the outcomes of low-molecular-weight heparin thromboprophylaxis among acutely ill medical inpatients in community practice.

METHODS: Using a large, geographically diverse, multihospital US database, we identified persons aged > or =40 years who had a hospital stay > or =6 days for an acute medical condition (including selected circulatory disorders, respiratory disorders, infectious diseases, or neoplasms) during calendar-year 2000. From these patients, those who received either enoxaparin thromboprophylaxis or no thromboprophylaxis were identified. Surgical patients, patients with nonthrombotic conditions requiring anticoagulant therapy, those transferred from or discharged to another acute care facility, and those medically ineligible for anticoagulation therapy were excluded. We compared the incidence of deep-vein thrombosis (DVT), pulmonary embolism (PE), all VTE (ie, DVT and/or PE), and death during the hospital stay in the 2 cohorts.

RESULTS: A total of 162 patients receiving enoxaparin thromboprophylaxis and 3557 receiving no thromboprophylaxis were identified. The risk of VTE over the course of hospitalization was 1.9% with enoxaparin thromboprophylaxis versus 6.2% with no thromboprophylaxis (relative risk = 0.30; P=0.023 ); mortality was similar in the 2 groups (8.0% vs 7.3; P=NS ).

CONCLUSIONS: Using hospital administrative data, we observed a 70% lower risk of VTE for hospitalized acutely ill medical patients receiving low-molecular-weight heparin thromboprophylaxis verus those receiving no thromboprophylaxis; these results are consistent with findings from clinical trials of low-molecular-weight heparin versus placebo. We conclude that the low-molecular-weight heparin enoxaparin is effective in reducing the risk of VTE in acutely ill medical inpatients in community practice.

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