Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
J Hosp Med. 2012 Jul-Aug;7(6):457-63. doi: 10.1002/jhm.1938. Epub 2012 Apr 2.
Both unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) are approved for venous thromboembolism (VTE) prophylaxis. Which agent is superior remains controversial.
To compare the effectiveness, complications, and costs of UFH and LMWH as VTE prophylaxis for hospitalized medical patients.
Retrospective cohort.
Three hundred thirty-three acute care facilities in 2004-2005.
Adults with 4 common medical diagnoses considered to carry moderate-to-high risk of VTE. Excluded were patients on warfarin or with hospital stays of ≤ 2 days. VTE prophylaxis was assessed from billing data.
None.
VTE, major bleeding or heparin-induced thrombocytopenia, mortality, and cost.
Of 32,104 patients who received prophylaxis, 55% received LMWH and the remainder received UFH. The hospital where the patient obtained care was the strongest predictor of receiving LMWH. VTE was observed in 163 (0.51%) patients; complications, followed by stopping therapy, were rare (<0.2%). In analysis adjusted for the propensity for UFH and other covariates, patients treated with UFH had an odds ratio for VTE of 1.04 (95% confidence interval [CI] 0.76 to 1.43) compared to LMWH. In a grouped treatment model, the odds of VTE with UFH was 1.14 (95% CI 0.72 to 1.81). Adjusted odds of bleeding with UFH compared to LMWH were 1.64 (95% CI 0.50 to 5.33), adjusted odds of complications followed by stopping prophylaxis were 2.84 (95% CI 1.43 to 45.66), and adjusted cost ratio was 0.97 (95% CI 0.90 to 1.05).
For VTE prophylaxis, the effectiveness and cost of LMWH and UFH are similar, but LMWH is associated with fewer complications.
普通肝素（UFH）和低分子肝素（LMWH）均被批准用于预防静脉血栓栓塞症（VTE）。哪种药物更优仍存在争议。
比较 UFH 和 LMWH 作为住院内科患者 VTE 预防的有效性、并发症和成本。
回顾性队列研究。
2004-2005 年的 333 家急症护理机构。
患有 4 种常见内科诊断的成年人，这些诊断被认为具有中度至高度 VTE 风险。排除正在服用华法林或住院时间≤2 天的患者。从计费数据评估 VTE 预防情况。
无。
VTE、大出血或肝素诱导的血小板减少症、死亡率和成本。
在接受预防治疗的 32104 名患者中，55%接受了 LMWH，其余接受了 UFH。患者接受治疗的医院是接受 LMWH 治疗的最强预测因素。163 名（0.51%）患者出现 VTE；并发症，其次是停止治疗，很少见（<0.2%）。在调整了 UFH 的倾向和其他协变量的分析中，与 LMWH 相比，接受 UFH 治疗的患者发生 VTE 的比值比为 1.04（95%置信区间[CI]0.76 至 1.43）。在分组治疗模型中，UFH 发生 VTE 的几率为 1.14（95%CI0.72 至 1.81）。与 LMWH 相比，UFH 发生出血的调整比值比为 1.64（95%CI0.50 至 5.33），调整后因并发症而停止预防治疗的比值比为 2.84（95%CI1.43 至 45.66），调整后的成本比为 0.97（95%CI0.90 至 1.05）。
对于 VTE 预防，LMWH 和 UFH 的有效性和成本相似，但 LMWH 与较少的并发症相关。
