A bomb was dropped on LMWH

[toughlife]

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Did any of you read the latest article on JAMA comparing unfractionated heparin to LMWH?

http://jama.ama-assn.org/cgi/reprint/296/8/935

After this study, and being that we live in a cost-containment environment, the days of LMWH seem numbered.

 

[deleted87051]

Study is for treatment of DVT. Around here LMWH is exclusively used for DVT prophylaxis in high risk surgical patients. It is possible that unfractionated heparin is just as effective as LMWH for this use too, but the study does not address this.

 

[toughlife]

Study is for treatment of DVT. Around here LMWH is exclusively used for DVT prophylaxis in high risk surgical patients. It is possible that unfractionated heparin is just as effective as LMWH for this use too, but the study does not address this.

Good point. I am sure someone will look into it since the difference in cost is so huge.

 

[VolatileAgent]

thanks for sharing, toughlife. couple things stick out to me.

first, they screened 2,430 and only randomized 708. also, why did 582 people flat-out refuse to participate in this study? there's some sort of screening/selection bias going on there. secondly, why didn't they blind it? lastly, this protocol looked at twice daily dosing head-to-head. lmwh is now approved for once-daily dosing for treatment, thus rendering the results of this study inconsistent with current clinical practice.

i don't think lovenox/fragmin/normiflo manufacturers need to panic just yet. also, this issue doesn't address/affect/change what we do as anesthesiologists (ie. neuraxials).

 

[toughlife]

thanks for sharing, toughlife. couple things stick out to me.

first, they screened 2,430 and only randomized 708. also, why did 582 people flat-out refuse to participate in this study? there's some sort of screening/selection bias going on there. secondly, why didn't they blind it? lastly, this protocol looked at twice daily dosing head-to-head. lmwh is now approved for once-daily dosing for treatment, thus rendering the results of this study inconsistent with current clinical practice.

i don't think lovenox/fragmin/normiflo manufacturers need to panic just yet. also, this issue doesn't address/affect/change what we do as anesthesiologists (ie. neuraxials).

The discussion addresses your questions. I am sure it will not change the way we practice but the impact it may have in the day-to-day use of LMWH will be interesting.

 

[SleepIsGood]

Yo Tough great article man.

Actually one of the attendings (actually a few) here in teh SICU hates lovenox. He lives by heparin alone. This article definitely shows why.

Like the attending says, the Lovenox lady brings in a great lunch every month, but if only her product was that good.😉