Venous Thromboembolism Prophylaxis following Acute Ischemic Stroke: A Retrospective Comparison of Unfractionated Heparin, Enoxaparin, and Fondaparinux

Purpose The objective of this study was to retrospectively review the efficacy and safety of unfractionated heparin (UFH), enoxaparin, and fondaparinux for venous thromboembolism (VTE) prevention following acute ischemic stroke. Methods A retrospective chart review was conducted of VTE and major bleeding event rates in patients receiving UFH, enoxaparin, or fondaparinux for VTE prophylaxis following ischemic stroke. This review included charts from an 18-month period at all facilities in the Lehigh Valley Health Network. A total of 889 patients were evaluated. Results There was no significant difference between the 3 anticoagulants for the primary outcome of VTE with an incidence of 2.5% (n=9) for UFH, 1.2% (n=3) for enoxaparin, and 0.4% (n=1) for fondaparinux ( P = .065). However, the incidence of major bleeding events was significantly different with an occurrence of 6.2% (n=22) for UFH, 3.2% (n=8) for enoxaparin, and 0.7% (n=2) for fondaparinux ( P = .001). A comparison of the individual agents showed that UFH had a significantly higher rate of major bleeding events when compared to fondaparinux ( P = .003). Conclusions In this study population, UFH was observed to increase the risk of major bleeding events in ischemic stroke patients receiving subsequent VTE prophylaxis. Additionally, the possibility of using fondaparinux for VTE prophylaxis in ischemic stroke patients appears to provide at least comparable safety and efficacy compared to UFH and enoxaparin. However, more studies are needed to determine the ideal anticoagulant and timing of prophylaxis in patients following ischemic stroke.