Abstract 203: Outcomes Comparison of Low Risk Medical and Surgical Patients Treated with Unfractionated Heparin vs. Enoxaparin
Notice bibliographique
Résumé
Objectives: We sought to compare the relative risks for adverse arterial vascular events in patients considered to be low risk for venous thromboembolism (VTE) events who were treated with enoxaparin compared to unfractionated heparin (UFH) for VTE prophylaxis, while comparing clinical efficacy for VTE and overall inpatient costs. Methods: We retrospectively identified patients admitted to the medical and general surgical services who received VTE prophylaxis with either UFH or enoxaparin and compared outcomes before and after implementation of a evidenced based anticoagulation protocol during a twelve month period. Exclusions were: (1) high risk surgical patients, specifically patients undergoing orthopedic, cardiovascular, and bariatric surgery; (2) high risk medical patients, specifically patients admitted with, or having a history of, pulmonary embolism (PE), deep venous thrombosis, atrial fibrillation, or valve replacement; and (3) patients with a therapeutic INR (>2.0) on admission. Using Logistic regression analysis, the following outcomes were compared between the UFH and enoxaparin treated groups: deep venous thrombosis, PE, myocardial infarction (MI), stroke, transient ischemic attack (TIA), heparin induced thrombocytopenia (HIT) and mortality among both groups. Length of hospital stay (LOS) and length of intensive care unit (ICU) LOS were compared using multiple regression analysis. Total costs between the two treatment groups were also compared using a t-test. Results: From the study group, a total of 6,390 patients received UFH prophylaxis and 1,565 received enoxaparin. The enoxaparin patients’ average age was younger than the UFH treated patients’ age by 2.4 years (59.1 and 61.5 years old, respectively, p<0.0001). The incidence of deep venous thrombosis, PE and HIT was similar in both groups. The enoxaparin group had a 52% higher odds for TIA (3.64 vs. 2.49 per 100 patients, OR=1.52, CI 1.113,2.078, p= 0.0024), 61% higher odds for stroke (9.3 vs. 6.6 per 100 patients, OR=1.589, CI 1.298, 1.945, p= 0.0009), while having a 54% lower odds for MI (2.1 vs. 4.7 per 100 patients, OR=0.46,CI 0.32, 0.66, p<0.0001) and lower mortality rate (0 vs. 1.3 per 100 patients). The hospital LOS in the enoxaparin group was 0.73 days lower than in the heparin group (4.41 days vs. 5.13 days, p<0.0001) and the ICU LOS was also shorter by 0.6 days (0.095 vs. 0.69 days, p<0.0001). The total cost (20, 690 vs. 25,946 dollars) was lower in the enoxaparin group. Conclusions: In low-risk medical and general surgical patients, UFH was as effective as enoxaparin in the prevention of thromboembolic events, with no difference in the incidence of HIT. When compared to UFH, enoxaparin was associated with lower MI and mortality rates, and shorter LOS and ICU LOS, at the expense of higher rates of stroke and TIA. Enoxaparin was associated with lower total inpatient costs than UFH.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».