Samuel Sophie, Li Wen, Dunn Koren, Cortes Jennifer, Nguyen Thuy, Moussa Daniel, Kumar Abhay, Dao Thanh, Beeson James, Choi H Alex, McCullough Louise D
Department of Pharmacy, Memorial Hermann-Texas Medical Center, 6411 Fannin Street, Houston, TX, 77030, USA.
Department of Internal Medicine, The University of Texas McGovern Medical School at Houston, Houston, USA.
J Thromb Thrombolysis. 2023 May;55(4):617-625. doi: 10.1007/s11239-023-02795-w. Epub 2023 Apr 8.
Venous thromboembolism (VTE) is a common complication in hospitalized patients. Pharmacologic prophylaxis is used in order to reduce the risk of VTE events. The main purpose of this study is to compare the prevalence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients admitted to the intensive care unit (ICU) who received unfractionated heparin (UFH) versus enoxaparin as VTE prophylaxis. Mortality was evaluated as a secondary outcome. This was a Propensity Score Adjusted Analysis. Patients admitted to neurology, surgical, or medical ICUs and screened with venous doppler ultrasonography or computed tomography angiography for detection of VTE were included in the analysis. We identified 2228 patients in the cohort, 1836 (82.4%) patients received UFH and 392 (17.6%) patients received enoxaparin. Propensity score matching yielded a well-balanced cohort of 950 (74% UFH, 26% enoxaparin) patients. After matching, there was no difference in prevalence of DVT (RR 1.05; 95% CI 0.67-1.64, p = 0.85) and PE (RR 0.76; 95% CI, 0.44-1.30, p = 0.31). No significant differences in location and severity of DVT and PE between the two groups were detected. Hospital and intensive care unit stay was similar between the two groups. Unfractionated heparin was associated with a higher rate of mortality, (HR 2.04; 95% CI, 1.13-3.70; p = 0.019). The use of UFH as VTE prophylaxis in ICU patients was associated with a similar prevalence of DVT and PE compared with enoxaparin, and the site and degree of occlusion were similar. However, a higher mortality rate was seen in the UFH group.
静脉血栓栓塞症（VTE）是住院患者常见的并发症。使用药物预防措施以降低VTE事件的风险。本研究的主要目的是比较入住重症监护病房（ICU）并接受普通肝素（UFH）与依诺肝素进行VTE预防的患者中深静脉血栓形成（DVT）和肺栓塞（PE）的发生率。将死亡率作为次要结局进行评估。这是一项倾向评分调整分析。分析纳入了入住神经科、外科或内科ICU并接受静脉多普勒超声检查或计算机断层血管造影筛查以检测VTE的患者。我们在队列中识别出2228例患者，其中1836例（82.4%）患者接受UFH，392例（17.6%）患者接受依诺肝素。倾向评分匹配产生了一个均衡的队列，包括950例患者（74%接受UFH，26%接受依诺肝素）。匹配后，DVT的发生率（RR 1.05；95% CI 0.67 - 1.64，p = 0.85）和PE的发生率（RR 0.76；95% CI，0.44 - 1.30，p = 0.31）没有差异。两组之间DVT和PE的部位及严重程度未检测到显著差异。两组的住院时间和重症监护病房停留时间相似。普通肝素与较高的死亡率相关（HR 2.04；95% CI，1.13 - 3.70；p = 0.019）。与依诺肝素相比，在ICU患者中使用UFH进行VTE预防时，DVT和PE的发生率相似，且阻塞部位和程度相似。然而，UFH组的死亡率较高。
