Evidence-based venous thromboembolism (VTE) prophylaxis guidelines often recommend VTE prophylaxis with low-molecular-weight heparin (LMWH) in at-risk hospitalized patients. Frequently, US hospitals may keep as few as one LMWH in their hospital formulary. We evaluated whether the choice of LMWH impacts the rates of hospital-acquired VTE.
The Premier Perspective database (July 2005-December 2006) was queried for hospitals that administered ≥ 1 order of LMWH (enoxaparin, dalteparin, tinzaparin) and had a ≥ 500 discharges during the study period. Each hospital was assigned to enoxaparin, dalteparin, or tinzaparin groups if > 80% of LMWH orders were for the corresponding drug. A hospital is assigned to the group: Mixture, if it can not be assigned to the three individual drug groups. The rate of hospital-acquired VTE was calculated for each hospital, with the mean compared between groups.
A total of 404 hospitals met the inclusion criteria. Only 1 hospital has any substantial usage ( > 1% of LMWH orders) of tinzaparin and thus is not included in any further analysis. Among the remaining 403 hospitals, 387 (96.0%) are in the enoxaparin group, 6 (1.5%) are in the dalteparin group, and 10 (2.5%) are in the Mixture group. 301 (74.7%) hospitals used only enoxaparin among LMWH. No hospital used only dalteparin. Among hospitals in the enoxaparin group, the average usage of enoxaparin is 99.4% of all LMWH. In the dalteparin group, the average usage of dalteparin is 89.0%. In the mixture group, the usage of enoxaparin and dalteparin is 58.4% and 41.6% respectively. The mean hospital-acquired VTE rate was significantly lower in the enoxaparin group than in both the dalteparin group (0.7% vs 1.6%, relative risk reduction [RRR] 53%, p < 0.001) and the mixture group (0.7% vs 1.1%, RRR 36%, p = 0.003).
Discharge information from a large, national hospital database indicates that enoxaparin is used as the only LMWH drug in about 3 out of every 4 US hospitals.
Hospitals that used predominantly enoxaparin vs. dalteparin have a lower rate of hospital-acquired VTE, with a 53% RRR.
Alpesh Amin, Grant monies (from industry related sources) Alpesh Amin has received research honorarium from sanofi-aventis U.S. Inc; Employee Jay Lin is an employee of sanofi-aventis US, Inc.; Consultant fee, speaker bureau, advisory committee, etc. Alpesh Amin is on the speakers bureau for sanofi-aventis U.S. Inc; Other The authors received editorial/writing support in the preparation of this abstract funded by sanofi-aventis U.S., Inc. The authors were fully responsible for all content and editorial decisions and received no financial support or other form of compensation related to the development of the manuscript.; No Product/Research Disclosure Information