Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA.
Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA.
J Thromb Haemost. 2018 Dec;16(12):2492-2500. doi: 10.1111/jth.14317. Epub 2018 Nov 15.
Essentials Critically ill cancer patients require pharmacologic prophylaxis for venous thromboembolism (VTE). Patients from 566 hospitals in the United States between 2010 and 2014 were included. Low-molecular-weight heparin (LMWH) prophylaxis was not associated in a reduction of VTE rates. LMWH prophylaxis was associated with a reduction in bleeding and heparin induced thrombocytopenia. SUMMARY: Background Critically ill patients with cancer are at increased risk of venous thromboembolism (VTE) from physical and cellular factors, requiring pharmacologic prophylaxis to reduce the risk of VTE. Objectives To assess whether low-molecular-weight heparin (LMWH) prophylaxis reduces in-hospital rates of VTE or improves clinical outcomes compared with unfractionated heparin (UFH) prophylaxis in critically ill patients with cancer. Methods We used a propensity-matched comparative-effectiveness cohort from the Premier Database. Patients aged 18 years or older with a primary diagnosis of cancer, intensive care unit admission and VTE prophylaxis within 2 days of admission between 1 January 2010 and 31 December 2014 were included. Patients were divided into LMWH or UFH prophylaxis groups. Results A total of 103 798 patients were included; 75 321 (72.6%) patients received LMWH and 28 477 (27.4%) patients received UFH. Propensity analysis matched (2 : 1) 42 343 LMWH patients and 21 218 UFH patients. Overall, LMWH was not associated with a decreased incidence of VTE (5.32% vs. 5.50%). LMWH prophylaxis was associated with a reduction in pulmonary embolism (0.70% vs. 0.99%), significant bleeding (13.3% vs. 14.8%) and heparin-induced thrombocytopenia (HIT) (0.06% vs. 0.19%). In non-metastatic solid disease, LMWH was associated with decreased VTE (4.27% vs. 4.84%) and PE (0.47% vs. 0.95%). Conclusions The use of an LMWH for VTE prophylaxis was not associated with a reduction in the incidence of in-hospital VTE as compared with UFH, but was associated with significant reductions in PE, clinically important bleeding events, and incidence of HIT in critically ill patients with cancer.
癌症危重症患者需要进行药物预防静脉血栓栓塞症（VTE）。本研究纳入了 2010 年至 2014 年间美国 566 家医院的患者。低分子肝素（LMWH）预防治疗与 VTE 发生率的降低无关。LMWH 预防治疗与出血和肝素诱导的血小板减少症的减少相关。
背景癌症危重症患者存在因生理和细胞因素导致静脉血栓栓塞症（VTE）的风险增加，需要进行药物预防以降低 VTE 的风险。目的评估与未分级肝素（UFH）预防相比，低分子肝素（LMWH）预防是否降低癌症危重症患者住院期间 VTE 的发生率或改善临床结局。
方法我们使用 Premier 数据库中的倾向匹配比较有效性队列。纳入年龄≥18 岁、主要诊断为癌症、入 ICU 并在入院后 2 天内接受 VTE 预防治疗的患者。患者分为 LMWH 或 UFH 预防组。
结果共纳入 103798 例患者；75321 例（72.6%）患者接受 LMWH 预防，28477 例（27.4%）患者接受 UFH 预防。通过倾向分析匹配了 42343 例 LMWH 患者和 21218 例 UFH 患者。总体而言，LMWH 预防并未降低 VTE 的发生率（5.32% vs. 5.50%）。LMWH 预防与肺栓塞（0.70% vs. 0.99%）、显著出血（13.3% vs. 14.8%）和肝素诱导的血小板减少症（HIT）（0.06% vs. 0.19%）的减少相关。在非转移性实体瘤疾病中，LMWH 预防与 VTE（4.27% vs. 4.84%）和 PE（0.47% vs. 0.95%）的减少相关。
结论与 UFH 相比，使用 LMWH 进行 VTE 预防与住院期间 VTE 发生率的降低无关，但与癌症危重症患者的 PE、临床显著出血事件和 HIT 发生率的显著降低相关。
