What is the clinical evidence from this study?

Study design: Cohort. Population: Obesity in hospitalized medical patients (n=67193). Intervention: Enoxaparin vs. Unfractionated heparin (UFH) ≤15,000 IU/day. Primary outcome: Venous thromboembolism (VTE) event during index hospitalization (aOR 0.71, 95% CI 0.57-0.88, p=0.0017).

June 16, 2023Frontiers in Cardiovascular MedicineOpen Access

Effectiveness, safety, and costs of thromboprophylaxis with enoxaparin or unfractionated heparin in inpatients with obesity

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Key result

Enoxaparin linked to ~29% lower VTE risk versus UFH in obese medical inpatients.

aOR 0.71
95% CI 0.57-0.88
P=0.0017
n=67,193

Why the study?

Obesity is a major risk factor for VTE, but the real-world effectiveness, safety, and costs of thromboprophylaxis among hospitalized adult inpatients with obesity are unknown.

Does enoxaparin improve clinical outcomes and reduce costs compared to unfractionated heparin for thromboprophylaxis in adult medical inpatients with obesity?

Population

67,193 adult medical inpatients with obesity hospitalized for ≥6 days

Comparison

Enoxaparin vs unfractionated heparin

Design

Retrospective cohort study

Follow-up

Index hospitalization and 90 days after index discharge

Authors

AAAlpesh AminHeart Failure / Cardiomyopathy AKAlex KartashovUniversity of North Carolina at Charlotte WNWilson NgaiMorristown Medical Center

Discussion

Member takes

Implication

Enoxaparin was associated with lower VTE odds in obese medical inpatients; hypothesis-generating and requires RCTs before practice change.

Study Design

Type

Cohort (n=67,193)

Multicenter

Yes

Structured PICO

Does enoxaparin improve clinical outcomes and reduce costs compared to unfractionated heparin for thromboprophylaxis in adult medical inpatients with obesity?

Population

67,193 adult medical inpatients (≥18 years old) with a primary or secondary discharge diagnosis of obesity, hospitalized for ≥6 days, excluding surgical patients, those with pre-existing VTE, and those receiving treatment-level doses of anticoagulants.

Intervention

Enoxaparin (≤40 mg/day) for thromboprophylaxis during index hospitalization.

Comparator

Unfractionated heparin (UFH) (≤15,000 IU/day) for thromboprophylaxis during index hospitalization.

Outcome

Incidence of VTE, pulmonary embolism (PE)-related mortality, overall in-hospital mortality, major bleeding, treatment costs, and total hospitalization costs during the index hospitalization and the 90 days after index discharge.hard clinical

Main Result

Effect estimate: aOR 0.71 (95% CI 0.57-0.88)

Absolute Event Rate: 0.48% vs 0.85%

p-value: p=0.0017

In adult medical inpatients with obesity, thromboprophylaxis with enoxaparin was associated with significantly lower risks of VTE, major bleeding, mortality, and costs compared to unfractionated heparin.

Limitations

Potential selection bias because the definition of obesity was based solely on ICD diagnosis codes
Database lacks data on some risk factors for VTE (such as immobility and smoking status) and creatinine values
Inaccurate or incomplete coding could have affected determinations of study eligibility, covariates, and outcomes
Patients who were readmitted to another hospital system would have been lost to follow-up
Excluded patients who received a weight-based dose or a higher fixed dose of enoxaparin

Cite This Study

Amin et al. (2023) conducted a cohort in Obesity in hospitalized medical patients (n=67,193). Enoxaparin vs. Unfractionated heparin (UFH) ≤15,000 IU/day was evaluated on Venous thromboembolism (VTE) event during index hospitalization (aOR 0.71, 95% CI 0.57-0.88, p=0.0017). Enoxaparin reduced the adjusted odds of venous thromboembolism by 29% (aOR 0.71) compared to unfractionated heparin during the index hospitalization of adult medical inpatients with obesity.

synapsesocial.com/papers/6a0eafe8aa1655e5fb22a82b https://doi.org/10.3389/fcvm.2023.1163684

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Implication

Enoxaparin was associated with lower VTE odds in obese medical inpatients; hypothesis-generating and requires RCTs before practice change.

Effectiveness, safety, and costs of thromboprophylaxis with enoxaparin or unfractionated heparin in inpatients with obesity

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Effectiveness, safety, and costs of thromboprophylaxis with enoxaparin or unfractionated heparin in inpatients with obesity

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider