title: Gold Medal Forum Winner. Unfractionated heparin three times a day versus enoxaparin in the prevention of deep vein thrombosis in trauma patients.
abstract: Venous thromboembolic disease is a significant source of morbidity and mortality in hospitalized trauma patients. Multiple drugs and dosing regimens have been suggested for pharmacoprophylaxis. In this study, we compared efficacy, complications, and cost of unfractionated heparin administered subcutaneously three times a day with standard-dosed enoxaparin for prophylaxis of deep venous thrombosis (DVT) in adult trauma patients over 1 year. Patients admitted for greater than 72 hours who received pharmacoprophylaxis as part of a comprehensive DVT protocol were included. A change was made in the protocol from enoxaparin (30 mg twice a day or 40 mg per day) to heparin (5000 U three times a day) at midyear. Surveillance lower extremity venous ultrasound was performed according to established institutional guidelines. Data, including demographics, associated injuries, complications, and cost, were collected and analyzed. Four hundred seventy-six patients met inclusion criteria. Two hundred thirty-seven (49.8%) patients received enoxaparin and 239 (50.2%) received heparin. Proximal lower extremity DVTs were detected in 16 (6.75%) patients in the enoxaparin group and 17 (7.11%) in the heparin group (P = 0.999). Risk factors for DVT in these patients included spinal cord injury (P = 0.001) and closed head injury (P = 0.031). There was no difference between the incidence of pulmonary emboli and bleeding. There was an estimated yearly pharmacy cost savings of $135,606. In trauma patients, subcutaneous heparin dosed three times a day may be as effective as standard-dosed enoxaparin for prophylaxis of venous thromboembolism without increased complications. Heparin three times a day for venous thromboembolism prophylaxis was associated with significant pharmaceutical cost savings.
authors.affiliation: Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee, USA. arnoljd5@hotmail.com
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Arnold
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Dart
authors.forename: Donald E
authors.initials: DE
authors.lastname: Barker
authors.forename: Robert A
authors.initials: RA
authors.lastname: Maxwell
authors.forename: Hans C
authors.initials: HC
authors.lastname: Burkholder
authors.forename: Vicente A
authors.initials: VA
authors.lastname: Mejia
authors.forename: Philip W
authors.initials: PW
authors.lastname: Smith
authors.forename: Joy M
authors.initials: JM
authors.lastname: Longley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000191:economics; D017046:Cost Savings; D017984:Enoxaparin / Q000008:administration & dosage* / Q000191:economics; D005260:Female; D016489:Head Injuries, Closed / Q000453:epidemiology; D006493:Heparin / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology; D013714:Tennessee; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000601:surgery; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin