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Published on: March 27, 2018
Comparison of Venous Thromboembolism Prophylactic Measures Post Coronary Artery Bypass Graft Surgery
H Andrew Wilsey1, Komal Pandya2,3, Craig Beavers2,3
1University of Kentucky HealthCare, Lexington, KY, USA. handreww@buffalo.edu.
Insights
Enoxaparin and unfractionated heparin showed similar rates of venous thromboembolism (VTE) and bleeding post-coronary artery bypass grafting (CABG). However, enoxaparin may be preferred due to improved secondary outcomes in VTE prophylaxis.
Area of Science:
- Cardiology
- Vascular Surgery
- Pharmacology
Background:
- Debate exists regarding optimal venous thromboembolism (VTE) prophylaxis post-coronary artery bypass grafting (CABG).
- Current guidelines offer weak recommendations and lack specific guidance on timing or agent choice for VTE prophylaxis.
Purpose of the Study:
- To compare the efficacy and safety of subcutaneous unfractionated heparin (UFH) versus enoxaparin for VTE prophylaxis in post-cardiac surgery patients.
- To evaluate primary outcomes of VTE and bleeding events, and secondary outcomes including resource utilization.
Main Methods:
- Retrospective cohort study of 1085 post-cardiac surgery patients (January 2013 - September 2017).
- 850 patients selected after propensity score matching, comparing subcutaneous UFH and enoxaparin.
- Primary outcomes: postoperative VTE and bleeding events up to 30 days. Secondary outcomes: chest tube output, mechanical ventilation duration, ICU and hospital length of stay, and readmission rates.
Main Results:
- Overall VTE and bleeding rates were 2.03% and 1.38%, respectively.
- Matched cohort showed no statistically significant difference in VTE (2.12% vs. 1.41%) or bleeding (1.18% vs. 0.94%) between UFH and enoxaparin groups.
- The UFH group experienced significantly higher chest tube output, days mechanically ventilated, and longer ICU and hospital stays.
Conclusions:
- No statistical difference in VTE or bleeding rates between UFH and enoxaparin for VTE prophylaxis post-CABG.
- Enoxaparin may be a preferred agent over UFH due to better secondary outcome results.
- Early VTE prophylaxis initiation resulted in bleeding rates comparable to published data.
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:
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:
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:
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.
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