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Year : 2022  |  Volume : 1  |  Issue : 1  |  Page : 3-9

Comparison of the effectiveness and safety of enoxaparin vs. unfractionated heparin for venous thromboembolism (VTE) prophylaxis in critically ill medical patients

1 Department of Pharmaceutical Care, King Abdulaziz Medical City; College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences; King Abdullah International Medical Research Center; Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia
2 Department of Pharmaceutical Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
3 Department of Statistics, European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
4 Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
5 Department of Clinical Pharmacy, Taif University, Taif, Saudi Arabia
6 Department of Pharmaceutical Care, King Fahad Hospital, Baha, Saudi Arabia
7 Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh; Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia

Correspondence Address:
Dr. Khalid Al Sulaiman
King Abdulaziz Medical City (KAMC), Ministry of National Guard Health Affairs (MNGHA), King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, PO Box 22490, 11426 Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjcp.SJCP_1_21

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Critically ill patients are more likely to acquire venous thromboembolism (VTE) due to various underlying factors, including severe illness, mechanical ventilation, sedative medications, and extended immobility. Thromboprophylaxis is a crucial component in critically ill patients’ management because of their high risk of VTE. However, there is uncertainty about the appropriate type of pharmacological VTE prophylaxis in critically ill patients admitted to the medical intensive care units (ICUs). Therefore, our study aims at evaluating the effectiveness and safety of standard dosing regimens (Enoxaparin vs. unfractionated heparin (UFH)) as a VTE prophylaxis in those populations. This is a retrospective cohort study included medical ICU patients aged ≥ 18 years with a normal body mass index (BMI) who received either Enoxaparin 40 mg daily or UFH 5000 Unit three times daily as a VTE prophylaxis between January 1, 2018 and December 31, 2018. The primary outcome was VTE and any case of thrombosis, and the secondary outcomes included complications during the ICU stay (i.e., major bleeding, minor bleeding, RBC transfusion during ICU stay, HAT, and HIT). A total of 1866 patients were screened; 311 patients were included in the study. The differences in VTE (OR 0.47; 95% CI 0.10–4.10; P = 0.49) and any case of thrombosis (OR 0.43;95%CI 0.14–1.32; P = 0.14) during ICU were similar between the two groups and not statistically significant. Conversely, patients who received enoxaparin have a higher incidence of major bleeding, specifically GI bleeding, compared with UFH (OR 3.30; 95% CI 0.85–12.61; P = 0.08); however, it is not statistically significant. Standard dosing of enoxaparin in critically ill medical patients was not associated with thrombosis benefit, but it is linked with higher odds of GI bleeding.

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