Amin Alpesh N, Lin Jay, Lenhart Greg, Schulman Kathy L
University of California - Irvine, Orange, CA 92868, USA.
Thromb Haemost. 2009 Aug;102(2):321-6. doi: 10.1160/TH09-03-0147.
Clinical and economic outcomes were compared following appropriate prophylaxis with enoxaparin or unfractionated heparin (UFH) in a large, real-world population of US hospitalised medical and surgical patients at risk of venous thromboembolism (VTE). Discharges from the Thomson Reuters MarketScan Hospital Drug Database (January 2004-March 2007) of patients aged > or =40 years, at risk of VTE according to the 7(th) American College of Chest Physicians (ACCP) guidelines, who spent > or =6 days in hospital and received appropriate ACCP-recommended enoxaparin or UFH prophylaxis were included. Patients with contraindications to anticoagulation were excluded. Hospital-acquired VTE, adverse events, and hospital costs for enoxaparin versus UFH were compared using univariate and multivariate analyses. Of the 5,136 discharges included, 4,014 (78%) received enoxaparin and 1,122 (22%) received UFH. Compared with UFH, enoxaparin was associated with significantly lower risk of hospital-acquired VTE (adjusted odds ratio [OR] 0.51, 95% confidence interval [CI] 0.30-0.86, p = 0.012), pulmonary embolism (adjusted OR 0.33, 95% CI 0.14-0.79, p = 0.013) or adverse events (adjusted OR 0.73, 95% CI 0.54-0.98, p = 0.034). Total hospital costs per discharge were lower for enoxaparin (US $16,865 +/- 10,979) than UFH (US $19,252 +/- 14,970), with a mean difference of US $2,388 in favour of enoxaparin (p < 0.001) (adjusted difference US $439, 95% CI US $ -39 to 909, p = 0.072). In patients at risk of VTE, appropriate enoxaparin prophylaxis was associated with a reduction in hospital-acquired VTE, adverse events, and costs compared with appropriate UFH prophylaxis. Increased appropriate use of enoxaparin in patients at risk of VTE may help to reduce the clinical and economic burden of this condition.
在一大群有静脉血栓栓塞（VTE）风险的美国住院内科和外科患者中，比较了依诺肝素或普通肝素（UFH）进行适当预防后的临床和经济结果。数据来自汤森路透市场扫描医院药品数据库（2004年1月至2007年3月）中年龄≥40岁、根据美国胸科医师学会（ACCP）第7版指南有VTE风险、住院时间≥6天且接受了ACCP推荐的依诺肝素或UFH预防的患者。排除有抗凝禁忌证的患者。使用单因素和多因素分析比较依诺肝素与UFH的医院获得性VTE、不良事件和医院费用。在纳入的5136例出院患者中，4014例（78%）接受了依诺肝素，1122例（22%）接受了UFH。与UFH相比，依诺肝素与医院获得性VTE风险显著降低相关（调整后的优势比[OR]为0.51，95%置信区间[CI]为0.30 - 0.86，p = 0.012），肺栓塞（调整后的OR为0.33，95%CI为0.14 - 0.79，p = 0.013）或不良事件（调整后的OR为0.73，95%CI为0.54 - 0.98，p = 0.034）。依诺肝素每次出院的总医院费用（16,865美元±10,979美元）低于UFH（19,252美元±14,970美元），平均差值为2388美元，有利于依诺肝素（p < 0.001）（调整后的差值为439美元，95%CI为 - 39美元至909美元，p = 0.072）。在有VTE风险的患者中，与适当的UFH预防相比，适当的依诺肝素预防与医院获得性VTE、不良事件和费用的减少相关。在有VTE风险的患者中增加依诺肝素的适当使用可能有助于减轻这种疾病的临床和经济负担。
