Prophylactic Anticoagulation Preferred Over Mechanical Devices

Prophylactic anticoagulation results in a lower risk of dying among patients in the intensive care unit (ICU) compared with the use of mechanical devices for protection against venous thromboembolism (VTE), according to new research.

Craig M. Lilly, MD, of the University of Massachusetts Memorial Medical Center in Worcester and colleagues reported their findings online in Chest.

The observational study of more than 87,000 patients matched for propensity to receive VTE prophylaxis found those managed with prophylactic anticoagulation had a clinically significant 19% lower risk of dying in the ICU and a 16% lower risk of dying in the hospital overall than no VTE prophylaxis (P <0.0001 for both). The study observed 294,896 episodes of critical illness among adults in 271 geographically dispersed adult intensive care units in the United States.

However, mechanical devices without anticoagulation were associated with 11% greater in-hospital mortality risk compared with no prophylaxis after adjustment for severity of illness, mechanical ventilation, and other factors, the researchers found. The findings suggest that the devices reduce the protection from anticoagulation in ICU patients and could be harmful under certain conditions.

The researchers cautioned that there were clinically important differences among treatment groups that may have introduced bias that could not be entirely adjusted out in their analyses.