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Apr 05, 2011

Use of Heparin Drugs in Critically Ill Patients

Slight differences exist between 2 types of blood clot treatments. 

When critically ill patients are treated in the intensive care unit, their fragile health can put them at risk for many types of complications. One of the most common complications, venous thromboembolism, occurs when a blood clot forms in a vein and blocks blood flow throughout the body. To help prevent these clots from forming, two types of medicine are most commonly administered to critically ill patients – low-molecular-weight heparin, such as dalteparin, or unfractioned heparin. While research has shown that both drugs demonstrate health benefits in throboprophylaxis trials over placebo, few have compared the relative health benefits between the two types of heparin treatments.

Consequently, a recent study published in the New England Journal of Medicine on March 22nd, 2011 investigated this relationship, comparing the health benefits of low-molecular-weight heparin with unfractionated heparin on venous thromboembolism, bleeding, and other outcomes common in critically ill patients. This study was implemented in multiple medical centers around the world that randomly assigned heparin drugs to over 3,760 intensive care unit patients. Study participants were monitored over time, undergoing compression ultrasonography, a process used to identify proximal let deep-vein thrombosis, along with various other types of testing. After analysis, data actually showed no significant difference in the rate of proximal leg deep-vein thrombosis in patients treated with low-molecular-weight heparin versus unfractioned heparin. Venous thrombosis occurred in 96 of 1873 patients receiving dalteparin in comparison with 109 of 1873 patients receiving unfractioned heparin – a difference in only 0.7% of study participants.  There were also no significant differences in major bleeding or death in patients on either drug. However, the occurrence of pulmonary emboli and heparin-induced thrombocytopenia were significantly lower in patients with dalteparin than unfractionated heparin.

Results from this study are extremely useful in providing direction for future research on the use of heparin drugs in critically ill patients. Although differences in venous thromboembolism, bleeding and death were not considered scientifically significant in this particular study, results might be different if the study were to be executed on a larger scale. Likewise, additional research is necessary to further compare the effects of both types of heparin drugs on pulmonary emboli and heparin-induced thrombocytopenia. While these conditions occurred significantly less in patients treated with dalteparin, more data is needed to support these findings. Ultimately, through additional research similar to the recent study investigating the use of heparin drugs, risk for various complications in critically ill patients can eventually be reduced considerably.

Questions for You to Consider

  • What is venous thromboembolism and why is it dangerous?

  • Venous thromboembolism occurs when a clot forms in a vein, which can slow or completely block blood flow. The danger is that if these clots form in deep veins (most often in the leg or pelvis), they can break off and travel to the lungs or heart causing a pulmonary embolism. A pulmonary embolism can prevent your body from getting the oxygen that it needs, inflicting serious damage on internal organs.
  • What are symptoms of a deep venous thrombosis?

  • Blood clots most often occur in the leg or pelvis, but can also develop in the arm. Blood clots in the arm or leg can cause pain, swelling or discoloration of the limb, as well as a slight fever. However, some clots can present no symptoms, especially when occurring in the pelvis.

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Resources to Help You Compare Treatment Options

Guidance from the Agency for Healthcare Research and Quality (AHRQ) in making health decisions