PURPOSE: Treatment options for venous thromboembolism (VTE) include protocol driven unfractionated heparin (UFH) or low-molecular-weight heparins (LMWH) followed by oral warfarin. LMWH has been associated with decreased hospital length of stay (LOS) and fewer complications. The purpose of this study was to evaluate the time required to achieve therapeutic anticoagulation with UFH and to compare the complication rate, outcome, and hospital LOS for patients treated with UFH versus LMWH.
METHODS: Retrospective chart review of patients with the diagnosis of VTE treated with anticoagulation from 2005 to 2007. Patients who received thrombolytics were excluded.
RESULTS: We identified 100 patients, 74 received UFH and 26 LMWH; average age was 58 in both group. No differences were noted in co-morbid conditions or in renal or liver function. The incidence of malignancy was similar (15%) in both groups. The mean time to reach therapeutic PTT in the UFH group was 46±24 hours. Less than 50% of patients in the UFH had PTT monitored every 6 hours as per institutional guidelines. UFH group had higher rates of complications (22 vs. 3 complications, p=0.04) and increased mortality (17 vs. 0 deaths, p=0.007). There were 73 (99%) and 22 (86%) patients with pulmonary embolism (PE) in the UFH and LMWH respectively. The 17/100 deaths (17%) were in the UFH, (16 PE, 1DVT). Causes of deaths in the PE group were: PE 9 (56%), others 6 (38%) and bleeding complications in one (6%). LOS was similar.
CONCLUSION: Despite established institutional guidelines there were delays in reaching a therapeutic level of anticoagulation with UFH. Mortality and complications were higher in the UFH group. Bleeding complications in our study were higher than reported in the literature.
CLINICAL IMPLICATIONS: Based on our study we recommend the use of LMWH to decrease morbidity and mortality in patients with VTE. If UFH is to be used, we recommend implementing a protocol based anticoagulant dosing and monitoring to improve patient care and safety as recommended by national patient safety goal.
DISCLOSURE: Pedro Sevilla Saez-Benito, None.