Thromboprophylaxis in at-risk medical inpatients was associated with significantly lower risk-adjusted mortality compared to no prophylaxis (P<0.001), except in patients with ischemic stroke.
Cohort (n=2,367,362)
Yes
Does thromboprophylaxis reduce mortality in medically ill patients at risk for venous thromboembolism?
In at-risk medical inpatients, thromboprophylaxis is associated with lower risk-adjusted mortality, and LMWH use is associated with lower total hospital costs compared to UFH.
p-value: p=<0.001
PURPOSE: According to guidelines from the American College of Chest Physicians, low-molecular-weight heparin (LMWH) and unfractionated heparin (UFH) should be prescribed to medical (nonsurgical) patients at high risk of venous thromboembolism. Thromboprophylaxis and mortality rates were determined in medical inpatients with indications for thromboprophylaxis. Cost differences between patient groups were investigated and are discussed. SUMMARY: Using Solucient's ACTracker Inpatient Database, medical discharges between January 2001 and December 2004 were extracted and patients who had indications for thromboprophylaxis (acute myocardial infarction, ischemic stroke, cancer, heart failure, or severe lung disease) were identified. Patients < 40 years or with deep-vein thrombosis or pulmonary embolism, active peptic ulcer, malignant hypertension, blood disease, HIV infection, or intubation of gastrointestinal or respiratory tract were excluded. Rates of thromboprophylaxis and mortality were compared between groups. Mean total drug costs and hospital costs per patient discharge were compared between patient groups. Of 12, 887, 080 medical discharges extracted from 330 hospitals, there were 2, 367, 362 patients with indications for thromboprophylaxis. Patients were subdivided on the basis of whether they received thromboprophylaxis (n = 717, 850) or not (n = 1, 649, 512). The thromboprophylaxis rate was low, despite increasing from 26% to 33% over the study period. Patients receiving thromboprophylaxis had significantly lower risk-adjusted mortality rates than those who did not (p < 0. 001), except those with ischemic stroke. The mean total drug cost per patient receiving LMWH and UFH (791 and 569, respectively) was higher than for patients not receiving thromboprophylaxis (372) (p < 0. 001). The mean total hospital cost per patient receiving UFH (7615) was higher than for LMWH (6866, p < 0. 001). CONCLUSION: The thromboprophylaxis rate among medical patients was low, with no significant improvement between 2001 and 2004. Thromboprophylaxis can impact patient mortality rates. Economic evaluation revealed that the use of LMWH for thromboprophylaxis in at-risk medical patients was associated with higher total drug costs but lower total hospital costs than UFH. Efforts should be made to increase clinicians' awareness of clinical guidelines.
Burleigh et al. (2006) conducted a cohort in Medically ill patients at risk for venous thromboembolism (n=2,367,362). Thromboprophylaxis (LMWH or UFH) vs. No thromboprophylaxis was evaluated on Risk-adjusted mortality rates (p=<0.001). Thromboprophylaxis in at-risk medical inpatients was associated with significantly lower risk-adjusted mortality compared to no prophylaxis (P<0.001), except in patients with ischemic stroke.