| Low-molecular-weight heparin prophylaxis of deep vein thrombosis for older patients with restricted mobility: propensity analyses of data from two multicentre, cross-sectional studies. | |
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MedLine Citation:
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PMID: 19358621 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Although older patients with restricted mobility are at increased risk for venous thromboembolism, they are under-represented in clinical trials evaluating prophylactic treatments against deep vein thrombosis (DVT). OBJECTIVE: To determine whether prolonged prophylaxis with low-molecular-weight heparin (LMWH) is associated with a lower rate of DVT in older patients with restricted mobility. METHODS: Two cross-sectional studies were conducted in 50 hospital-based, post-acute care facilities in France in 2001 and 2003. The studies included 1603 evaluable patients aged >or=65 years, including 866 LMWH users (median treatment duration 23 days; interquartile range 13-42) and 737 LMWH non-users. All patients underwent complete compression ultrasonography performed by board-certified vascular medicine physicians. The primary study outcome was proximal DVT. Propensity analyses were used to control for bias in LMWH treatment assignment. RESULTS: The rate of proximal DVT was 4% (35/866) and 5.7% (42/737) for LMWH users and non-users, respectively (p = 0.16). Prophylaxis with LMWH was associated with decreased odds of proximal DVT after adjusting for baseline characteristics (odds ratio [OR] 0.56; 95% CI 0.33, 0.95; p = 0.03) or quintile of propensity score (OR 0.58; 95% CI 0.35, 0.99; p = 0.04). In propensity matched analysis, 342 LMWH users were at decreased odds of proximal DVT compared with 342 non-users (OR 0.50; 95% CI 0.24, 1.00; p = 0.04). The decrease in proximal DVT was paralleled by a similar decrease in distal DVT. Compared with non-users, only high-risk dose users had decreased odds of DVT. CONCLUSIONs: In this observational study, prophylaxis with a high-risk dose of LMWH was associated with decreased odds of proximal DVT in older patients with restricted mobility. Further study is needed before recommending routine prophylaxis with LMWH in these patients. |
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Authors:
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José Labarère; Marie-Antoinette Sevestre; Joël Belmin; Annie Legagneux; Marie-Thérèse Barrellier; Hélène Thiel; Philippe Le Roux; Gilles Pernod; Jean-Luc Bosson; |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Drugs & aging Volume: 26 ISSN: 1170-229X ISO Abbreviation: Drugs Aging Publication Date: 2009 |
Date Detail:
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Created Date: 2009-04-10 Completed Date: 2009-06-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9102074 Medline TA: Drugs Aging Country: New Zealand |
Other Details:
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Languages: eng Pagination: 263-71 Citation Subset: IM |
Affiliation:
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Quality of Care Unit, Grenoble University Hospital, Grenoble, France. JLabarere@chu-grenoble.fr |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Anticoagulants / administration & dosage, adverse effects, therapeutic use* Controlled Clinical Trials as Topic Cross-Sectional Studies Dose-Response Relationship, Drug Female Heparin, Low-Molecular-Weight / administration & dosage, adverse effects, therapeutic use* Humans Male Mobility Limitation* Risk Factors Venous Thrombosis / prevention & control*, ultrasonography |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Heparin, Low-Molecular-Weight |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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