I'm sorry for my stupid question
Why do we prescribe UFH for the DVT prophylaxis twice or three times daily but not three or five times?
Thank you for your reply!
Have you read this article?
Every one of your posts feels like a trap/setup for some discussion...seemingly naive/innocent question in an apologetic manner followed by quoting studies, etc....it's sort of an annoying technique. Just bring up a controversial topic if you want to talk about it.
Anyway, it's late here in Wichita, so I'll have to find the sources later, but I'm pretty sure that Lovenox has been shown to be more effective than Dalteparin, so they're not the same just because they're both LMWH. I'll have to double check it, though.
As for cost, it really depends how you're dosing it and the frequency. In my hospital, SQ heparin costs $70/dose, which is $210/day at q8 hours, while Lovenox costs $200/dose, which is either $200 or $400/day based on how often you give it. I wasn't even familiar with generic enoxaparin, so that might make LMWH even cheaper.
For unfractionated heparin, I know that BID dosing has been shown to be inferior to TID dosing for DVT prophylaxis...so I'm not sure if BID dosing should even be discussed.
For TID heparin (5,000 units) versus once daily lovenox (40mg), the DVT rate will be about the same, so the benefit of LMWH comes in the decreased HIT and decreased bleeding complications. Those are real, and I'll find the studies tomorrow.
Both Lovenox and Heparin are reversible, although UFH is more predictably reversible with Protamine...you can still reverse LMWH with protamine but it's harder to measure response.
The above mentioned NEJM study
did show a statistically significant difference in PE rates between UFH and Dalteparin (p=0.01, although one could argue 1.3% vs. 2.3% is not clinically significant, tell that to the 19 extra people with PEs).
Another note is that in a trauma study that measured Factor 10a levels in critically ill patients, Lovenox 40mg daily did not give adequate prophylaxis, while 30mg q12 did...so I give 30q12 to my critically ill patients routinely.
Lastly, we talk about need to reverse, etc, but neither UFH or LMWH should be causing much significant bleeding at prophylactic doses. I give both types to patients preop/postop all the time without significant effects on bleeding.
I think UFH and LMWH both have roles in critical care, and I use both frequently. I think the major problem that I see is people holding these drugs inappropriately for surgery or minor bleeding.