Effectiveness and Safety of Prophylactic-Dose Heparin for Thromboprophylaxis in Hospitalized Inflammatory Bowel Disease Patients
PresenterFlash Talk Presenter
Ghadeer Dawwas, PhD, MSc, MBA is a postdoctoral fellow in the Department of Epidemiology, Biostatistics and informatics at the Perelman School of Medicine of the University of Pennsylvania. Dr. Dawwas’s research focuses on the comparative effectiveness and safety of medical products in selected patients’ populations who were often excluded or underrepresented in randomized clinical trials.
Hospitalized inflammatory bowel disease (IBD) patients are at increased risk of venous thromboembolism (VTE) and mortality.
To evaluate the effectiveness and safety of prophylactic-dose heparin compared with no anticoagulation in hospitalized IBD patients.
This was a retrospective cohort study using a hospital-based, all-payer database from Premiere Healthcare, which reflects 25% of all inpatient encounters in the U.S. We included adult patients with IBD who had a length of hospital stay ≥ 2 days from January 1, 2016, through December 31, 2019. We excluded patients who had other indications for anticoagulation (e.g., VTE, atrial fibrillation, mechanical heart valve), users of oral anticoagulants, and users of heparin at therapeutic-dose. The primary effectiveness outcome was a composite of VTE and all-cause in-hospital mortality. The primary safety outcome was a composite of intracranial bleeding and gastrointestinal bleeding. We used propensity score matching to reduce potential differences between users and non-users. We estimated relative risk (RR) and 95% confidence interval (CI) using logistic regression models.
The analysis included 8,840 IBD patients (n=4,420 for users and n=4,420 for non-users). The composite of in-hospital mortality and VTE occurred in 14 (0.3%) users and 46 (1.0%) non-users. In the adjusted analysis, prophylactic use of anticoagulants (vs. no use) was associated with a lower risk of VTE and all-cause mortality (RR, 0.33, 95% CI 0.18 to 0.61) with no difference in bleeding risk (RR, 0.85, 0.66 to 1.10). The results for the effectiveness and safety outcome remained consistent for VTE (RR, 0.26, 0.11 to 0.59) and all-cause mortality (RR, 0.43, 0.18 to 1.06).
In this comparative effectiveness and safety study of hospitalized IBD patients, prophylactic heparin was associated with a lower risk of VTE and all-cause mortality without increasing bleeding risk compared with no anticoagulation. Our results suggest potential benefits for prophylactic anticoagulation to reduce the burden of VTE in hospitalized IBD patients.
KeywordsApixaban, warfarin, anticoagulants, heparin, venous thromboembolism, inflammatory bowel disease, pharmacoepidemiology, gastroenterology
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