title: Comparison of injectable anticoagulants for thromboprophylaxis after cancer-related surgery.
abstract: OBJECTIVE
  The clinical and economic outcomes associated with using injectable anticoagulants for thromboprophylaxis after cancer-related surgery are evaluated.
  
  
  METHODS
  This retrospective cohort analysis was conducted from an institutional perspective using hospital administrative data and examined patients age 18 years or older who received unfractionated heparin (UFH), enoxaparin, dalteparin, or fondaparinux after undergoing cancer-related surgery. Outcomes assessed included venous thromboembolism (VTE) and major bleeding (MB) rates; VTE-related, MB-related, and all-cause readmission rates; mean length of stay (LOS); and mean total cost of care during hospitalization.
  
  
  RESULTS
  In the 4068 patients evaluated (1017 per group), VTE rates were similar for fondaparinux compared with the other anticoagulants. The risk of MB was 80% higher for enoxaparin (p = 0.035) and 2.5 times higher for UFH (p = 0.0004) but not significantly higher for dalteparin compared with fondaparinux. The mean LOS was 8% longer for patients taking enoxaparin (p = 0.03) and dalteparin (p = 0.0494) and 21% longer for those treated with UFH (p < 0.0001) compared with fondaparinux. The unadjusted mean ± S.D. total cost of care per patient was lower in the fondaparinux group compared with the enoxaparin and UFH groups but higher compared with dalteparin.
  
  
  CONCLUSIONS
  A retrospective evaluation of hospital administrative data for patients who had received thromboprophylaxis after cancer-related surgery revealed a similar risk of VTE with fondaparinux compared with other injectable anticoagulants. Fondaparinux was associated with a lower risk of MB compared with enoxaparin and UFH but did not differ significantly from dalteparin in this regard. A shorter LOS was observed for patients who received fondaparinux compared with dalteparin, enoxaparin, and UFH. The total cost of care for patients who received fondaparinux was lower compared with enoxaparin or UFH but higher compared with dalteparin.
authors.affiliation: Arun Changolkar, Ph.D., M.B.A., is President and Chief Executive Officer, SOAL Pharmatech Solutions, Inc., Philadelphia, PA; at the time of this study he was Manager, U.S. Health Outcomes, GlaxoSmithKline, Philadelphia. Laura Menditto, M.B.A., M.P.H., is Owner, Laura A. Menditto LLC, Newtown, PA; at the time of this study she was Director, Cardiovascular, Metabolic, and Oncology U.S. Health Outcomes, GlaxoSmithKline. Manan Shah, Pharm.D., Ph.D., is Director, Health Services and Outcomes Research, U.S. Medical, Bristol-Myers Squibb Company, Tampa, FL; at the time of this study he was Director, Health Economics and Outcomes Research, Xcenda, AmerisourceBergen Consulting Services, Palm Harbor, FL. Katarzyna Puto, Pharm.D., M.B.A., BCOP, BCPS, s Associate Director, Global Health Economics and Outcomes Research, Xcenda; at the time of this study she was Assistant Director, Medical Communications, Xcenda. Eileen Farrelly, M.P.H., is Associate Director, Xcenda.
authors.forename: Arun
authors.initials: A
authors.lastname: Changolkar
authors.forename: Laura
authors.initials: L
authors.lastname: Menditto
authors.forename: Manan
authors.initials: M
authors.lastname: Shah
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Puto
authors.forename: Eileen
authors.initials: E
authors.lastname: Farrelly
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin