No Mortality Benefit Found For Low-Molecular-Weight Heparin in Acutely Ill Patients Reply

Although venous thromboembolism (VTE) is a serious problem for acutely ill patients in the hospital, a new study published in the New England Journal of Medicine failed to find any improvement in mortality associated with thromboprophylaxis.

Ajay Kakkar and the LIFENOX investigators randomized 8307 acutely ill patients to enoxaparin or placebo for 10 days. All patients wore elastic stockings with graduated compression.

There was no difference in 30 day mortality or major bleeding between the groups:

  • 30 day mortality: 4.9% in the enoxaparin group versus 4.8% in the placebo group (p=0.83)
  • major bleeding: 0.4% versus 0.3% (p=0.35)

The findings, the authors write, “appear to be counterintuitive, given the fact that pharmacologic prophylaxis has been shown to reduce the risk of venous thromboembolism, including asymptomatic deep-vein thrombosis, by at least 45% in hospitalized, acutely ill medical patients.” But, they write in the conclusion, the results do not mean that thromboprophylaxis is not worthwhile:

Pharmacologic thromboprophylaxis continues to have proven benefits in preventing venous thromboembolism, thus reducing the need for the treatment of symptomatic venous thromboembolism with high doses of anticoagulant agents over a prolonged period of time. Furthermore, venous thromboembolism can lead to nonfatal complications such as the post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension, which are often not treated successfully.

Advertisements

What do you think?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s