title: Dalteparin versus Enoxaparin for the prevention of venous thromboembolic events in trauma patients.
abstract: BACKGROUND
  The use of low-molecular-weight heparin (LMWH) for the chemoprophylaxis of venous thromboembolism (VTE) in trauma patients is supported by Level-1 evidence. Because Enoxaparin was the agent used in the majority of studies for establishing the efficacy of LMWH in VTE, it remains unclear if Dalteparin provides an equivalent effect.
  
  
  OBJECTIVE
  To compare Dalteparin to Enoxaparin and investigate their equivalence as VTE prophylaxis in trauma.
  
  
  METHODS
  Trauma patients receiving VTE chemoprophylaxis in the Surgical Intensive Care Unit of a Level-1 Trauma Center from 2009 (Enoxaparin) to 2010 (Dalteparin) were included.
  
  
  METHODS
  The primary outcome was the incidence of clinically significant VTE. Secondary outcomes included heparin-induced thrombocytopenia (HIT), major bleeding, and drug acquisition cost savings. Equivalence margins were set between -5 and 5 %.
  
  
  RESULTS
  A total of 610 patient records (277 Enoxaparin, 333 Dalteparin) were reviewed. The two study groups did not differ significantly: blunt trauma 67 vs. 62 %, p = 0.27; mean Injury Severity Score (ISS) 17 ± 10 vs. 16 ± 10, p = 0.34; Acute Physiology and Chronic Health Evaluation (APACHE) II score 17 ± 9 vs. 17 ± 10, p = 0.76; time to first dose of LMWH 69 ± 98 vs. 65 ± 67 h, p = 0.57). The rates of deep venous thrombosis (DVT) (3.2 vs. 3.3 %, p = 1.00), pulmonary emboli (PE) (1.8 vs. 1.2 %, p = 0.74), and overall VTE (5.1 vs. 4.5 %, p = 0.85) did not differ. The absolute difference in the incidence of overall VTE was 0.5 % [95 % confidence interval (CI): -2.9, 4.0 %, p = 0.85]. The 95 % CI was within the predefined equivalence margins. There were no significant differences in the frequency of HIT or major bleeding. The total year-on-year cost savings, achieved with 277 patients during the switch to Dalteparin, was estimated to be $107,778.
  
  
  CONCLUSIONS
  Dalteparin is equivalent to Enoxaparin in terms of VTE in trauma patients and can be safely used in this population, with no increase in complications and significant cost savings.
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, LAC + USC Medical Center, 2051 Marengo Street, C5L100, Los Angeles, CA, 90033, USA.
authors.forename: O T
authors.initials: OT
authors.lastname: Okoye
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, LAC + USC Medical Center, 2051 Marengo Street, C5L100, Los Angeles, CA, 90033, USA.
authors.forename: R
authors.initials: R
authors.lastname: Gelbard
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, LAC + USC Medical Center, 2051 Marengo Street, C5L100, Los Angeles, CA, 90033, USA. kenji.inaba@med.usc.edu.
authors.forename: K
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, LAC + USC Medical Center, 2051 Marengo Street, C5L100, Los Angeles, CA, 90033, USA.
authors.forename: M
authors.initials: M
authors.lastname: Esparza
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, LAC + USC Medical Center, 2051 Marengo Street, C5L100, Los Angeles, CA, 90033, USA.
authors.forename: H
authors.initials: H
authors.lastname: Belzberg
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, LAC + USC Medical Center, 2051 Marengo Street, C5L100, Los Angeles, CA, 90033, USA.
authors.forename: P
authors.initials: P
authors.lastname: Talving
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, LAC + USC Medical Center, 2051 Marengo Street, C5L100, Los Angeles, CA, 90033, USA.
authors.forename: P G
authors.initials: PG
authors.lastname: Teixeira
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, LAC + USC Medical Center, 2051 Marengo Street, C5L100, Los Angeles, CA, 90033, USA.
authors.forename: L S
authors.initials: LS
authors.lastname: Chan
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, LAC + USC Medical Center, 2051 Marengo Street, C5L100, Los Angeles, CA, 90033, USA.
authors.forename: D
authors.initials: D
authors.lastname: Demetriades
keywords: Cost savings; Deep venous thrombosis; Low-molecular-weight heparin; Pulmonary embolism; Trauma; Venous thromboembolism prophylaxis
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