Comparison of Venous Thromboembolism Prophylactic Measures Post Coronary Artery Bypass Graft Surgery.
Aged
Anticoagulants
/ administration & dosage
Coronary Artery Bypass
/ methods
Enoxaparin
/ administration & dosage
Female
Hemorrhage
/ chemically induced
Heparin
/ administration & dosage
Humans
Length of Stay
Male
Middle Aged
Patient Readmission
/ statistics & numerical data
Postoperative Care
/ methods
Respiration, Artificial
/ statistics & numerical data
Retrospective Studies
Venous Thromboembolism
/ prevention & control
Journal
American journal of cardiovascular drugs : drugs, devices, and other interventions
ISSN: 1179-187X
Titre abrégé: Am J Cardiovasc Drugs
Pays: New Zealand
ID NLM: 100967755
Informations de publication
Date de publication:
Dec 2019
Dec 2019
Historique:
pubmed:
17
6
2019
medline:
21
4
2020
entrez:
17
6
2019
Statut:
ppublish
Résumé
There is considerable debate surrounding venous thromboembolism (VTE) prophylaxis in patients post coronary artery bypass grafting (CABG) procedures. The American College of Chest Physicians guidelines report weak recommendations for starting VTE prophylaxis, but provide no specific guidance regarding timing or preferred prophylactic agent. This retrospective cohort study was designed to compare outcomes of post-cardiac surgery patients admitted to the cardiovascular intensive care unit (ICU) who received subcutaneous unfractionated heparin (UFH), with those who received subcutaneous enoxaparin for VTE prophylaxis. Between January 2013 and September 2017, 1085 patients were identified, and, after propensity score matching, 850 patients were selected for analysis. The primary outcomes were postoperative VTE and the occurrence of bleeding events up to 30 days postoperatively. Secondary outcomes included chest tube output, days mechanically ventilated, ICU length of stay, total hospital length of stay, and 30-day readmission rates. During the study period, rates of 2.03% for VTE events and 1.38% for bleeding events were reported in the entire cohort. After matching, the rates of VTE events (2.12% vs. 1.41%, p = 0.43) and bleeding events (1.18% vs. 0.94%, p = 1.00) were more frequent in the heparin group versus the enoxaparin group; these differences were not statistically significant. However, we did find a statistically significant increase in several secondary endpoints, including chest tube output, days mechanically ventilated, ICU length of stay, and total hospital length of stay, within the heparin cohort. Bleeding rates were similar to those previously published, despite the early initiation of VTE prophylaxis. We report no statistical difference in the rates of VTE or bleeding between chemical agents, but our results suggest enoxaparin may be a preferred agent over UFH.
Sections du résumé
BACKGROUND
BACKGROUND
There is considerable debate surrounding venous thromboembolism (VTE) prophylaxis in patients post coronary artery bypass grafting (CABG) procedures. The American College of Chest Physicians guidelines report weak recommendations for starting VTE prophylaxis, but provide no specific guidance regarding timing or preferred prophylactic agent.
METHODS
METHODS
This retrospective cohort study was designed to compare outcomes of post-cardiac surgery patients admitted to the cardiovascular intensive care unit (ICU) who received subcutaneous unfractionated heparin (UFH), with those who received subcutaneous enoxaparin for VTE prophylaxis. Between January 2013 and September 2017, 1085 patients were identified, and, after propensity score matching, 850 patients were selected for analysis. The primary outcomes were postoperative VTE and the occurrence of bleeding events up to 30 days postoperatively. Secondary outcomes included chest tube output, days mechanically ventilated, ICU length of stay, total hospital length of stay, and 30-day readmission rates.
RESULTS
RESULTS
During the study period, rates of 2.03% for VTE events and 1.38% for bleeding events were reported in the entire cohort. After matching, the rates of VTE events (2.12% vs. 1.41%, p = 0.43) and bleeding events (1.18% vs. 0.94%, p = 1.00) were more frequent in the heparin group versus the enoxaparin group; these differences were not statistically significant. However, we did find a statistically significant increase in several secondary endpoints, including chest tube output, days mechanically ventilated, ICU length of stay, and total hospital length of stay, within the heparin cohort. Bleeding rates were similar to those previously published, despite the early initiation of VTE prophylaxis.
CONCLUSIONS
CONCLUSIONS
We report no statistical difference in the rates of VTE or bleeding between chemical agents, but our results suggest enoxaparin may be a preferred agent over UFH.
Identifiants
pubmed: 31203501
doi: 10.1007/s40256-019-00354-4
pii: 10.1007/s40256-019-00354-4
doi:
Substances chimiques
Anticoagulants
0
Enoxaparin
0
Heparin
9005-49-6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM