Comparison of injectable anticoagulants for thromboprophylaxis after cancer-related surgery

Arun Changolkar, Laura Menditto, Manan Shah, Katarzyna Puto, Eileen Farrelly
American Journal of Health-system Pharmacy: AJHP 2014 April 1, 71 (7): 562-9

PURPOSE: The clinical and economic outcomes associated with using injectable anticoagulants for thromboprophylaxis after cancer-related surgery are evaluated.

METHODS: This retrospective cohort analysis was conducted from an institutional perspective using hospital administrative data and examined patients age 18 years or older who received unfractionated heparin (UFH), enoxaparin, dalteparin, or fondaparinux after undergoing cancer-related surgery. Outcomes assessed included venous thromboembolism (VTE) and major bleeding (MB) rates; VTE-related, MB-related, and all-cause readmission rates; mean length of stay (LOS); and mean total cost of care during hospitalization.

RESULTS: In the 4068 patients evaluated (1017 per group), VTE rates were similar for fondaparinux compared with the other anticoagulants. The risk of MB was 80% higher for enoxaparin (p = 0.035) and 2.5 times higher for UFH (p = 0.0004) but not significantly higher for dalteparin compared with fondaparinux. The mean LOS was 8% longer for patients taking enoxaparin (p = 0.03) and dalteparin (p = 0.0494) and 21% longer for those treated with UFH (p < 0.0001) compared with fondaparinux. The unadjusted mean ± S.D. total cost of care per patient was lower in the fondaparinux group compared with the enoxaparin and UFH groups but higher compared with dalteparin.

CONCLUSION: A retrospective evaluation of hospital administrative data for patients who had received thromboprophylaxis after cancer-related surgery revealed a similar risk of VTE with fondaparinux compared with other injectable anticoagulants. Fondaparinux was associated with a lower risk of MB compared with enoxaparin and UFH but did not differ significantly from dalteparin in this regard. A shorter LOS was observed for patients who received fondaparinux compared with dalteparin, enoxaparin, and UFH. The total cost of care for patients who received fondaparinux was lower compared with enoxaparin or UFH but higher compared with dalteparin.

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