OBJECTIVES

Venous thromboembolism (VTE) affects 22% to 80% of critically ill patients. We found no comparison of fondaparinux and enoxaparin thromboprophylaxis in intensive care units (ICU). We compared fondaparinux and enoxaparin VTE rates for patients admitted to ICU.

METHODS

A retrospective cohort study was conducted using the Medical Information Mart for Intensive Care III database. Inclusion criteria were age 18 years or older and ICU admission. Exclusion criteria were VTE on admission, receiving warfarin or receiving both fondaparinux and enoxaparin. Patients were followed from admission until death or discharge. Propensity scores for receiving fondaparinux were generated using logistic regression based on age, sex, marital status, insurance status, admission type (elective versus emergency), and heparin use. Enoxaparin users were matched 2 to 1 to Fondaparinux users by propensity score. Outcomes assessed were VTE occurrence (ICD-9 codes: 453.4x, 453.8x, 453.9, 415.1, 415.11, or 415.19), ICU survival, and major bleeding (intracranial bleeding, i.e., ICD-9 code 432.9, or receiving packed red blood cells or whole blood). Logistic regression estimated association between drug used and VTE and Cox proportional hazard regression estimated association between drug used and survival, with step-wise selection of covariates. SAS 9.4 was used for analyses with an alpha of 0.05. Covariates in the regressions included age, sex, marital status, insurance status, admission type, heparin use and elixhauser comorbidity.

RESULTS

The 118 Fondaparinux patients identified (56% over 65 years, 57% male) were matched to 236 enoxaparin patients (56% over 65 years, 61% male). There was no difference in survival among cohorts (adjusted H.R. = 1.18, p = 0.56) and none had major bleeding. Fondaparinux users had less likelihood of VTE than enoxaparin users (adjusted O.R. = 0.33, p = 0.04).

CONCLUSIONS

The fondaparinux cohort had lower VTE risk than the enoxaparin cohort, but no difference in major bleeding or survival.