[Can home prophylaxis for venous thromboembolism reduce mortality rates in patients with chronic obstructive pulmonary disease?].
OBJECTIVE
The incidence of venous thromboembolism (VTE) in patients with chronic obstructive pulmonary disease (COPD) ranges from 20% to 60% in different studies and the mortality rates are higher for patients with both conditions. Heparin prophylaxis is therefore usually prescribed for COPD patients who are hospitalized for exacerbation. Once their situation becomes stable, however, they are discharged to home without prophylaxis even though the low level of physical activity their disease allows continues to put them at risk for VTE. The aim of this study was to test the efficacy of home heparin prophylaxis on reducing the incidence of VTE and on the overall mortality rate in patients with severe COPD.


METHODS
We conducted a prospective, randomized controlled trial of 87 patients with severe COPD who required home oxygen therapy (> or =18 h/d) and whose physical activity was highly restricted. A total of 44 patients received low molecular weight heparin (3500 IU/d of bemiparin) subcutaneously for 6 months. The outcome measures were incidence of VTE and mortality at 3 and 6 months.


RESULTS
Four patients (9.1%) died in the heparin group and 9 (20.4%) died in the control group; the difference was not statistically significant (P=.23). VTE without pulmonary embolism developed in 1 patient (2%) in each group. Slight bleeding complications appeared in 9 patients (20.4%) in the heparin group and 1 patient (2.3%) in the control group, a difference that was statistically significant (P=.015).


CONCLUSIONS
Home prophylaxis with heparin does not reduce the incidence of VTE or overall mortality in patients with severe COPD.
Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain. manumalap@ono.com
M
M
Modesto-Alapont
D
D
Nauffal-Manzur
E
E
Ansótegui-Barrera
R
R
Menéndez-Villanueva
A
A
Ballesta
R
R
Touza
M
M
Perpiñá-Tordera
D000368:Aged; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006701:Home Nursing; D006801:Humans; D008297:Male; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D013923:Thromboembolism / Q000209:etiology* / Q000401:mortality* / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000209:etiology* / Q000401:mortality* / Q000517:prevention & control*
D006495:Heparin, Low-Molecular-Weight; C411345:bemiparin