A clot (thrombus) that is formed in a vein (a type of blood vessel) can be in the leg, arm, gastrointestinal tract or elsewhere. This venous thrombus can break loose and then be carried by the blood stream to plug another vessel (venous thromboembolism). The travelling clot then plugs an artery (another type of blood vessel), commonly in the lung, where it has serious effects and can cause death. Venous thromboembolism is a very common and serious problem in critically ill patients, and is a preventable cause of death in the intensive care unit (ICU). Prevention of venous thromboembolism is a key component of care of critically ill patients to try to reduce the chance of clot formation, reduce the chance of embolization and reduce the risk of death. The anticoagulant drug heparin is an effective and save prevention strategy, used around the world.
Researchers from the CCCTG, led by Deborah Cook
, Maureen Meade, Peter Dodek, Gordon Wood, Vinay Dhingra, Dean Chittock, Sean Keenan, Jim Kutsiogiannis, Mike Jacka, Chip Doig, Bojan Paunovic, Geeta Mehta, Rob Fowler, John Granton, John Marshall, Niall Fergusson, Andreas Freitag, Tim Karachi, John Muscedere, Michael Sharpe, Lauralyn McIntyre, Joe Pagliarello, Bill Plaxton, Gerald Hollinger, Johnathan Eisenstat, Germain Poirier, Yoanna Skrobik, Stephane Langevin, Kosar Khwaja, Martin Albert, Francois Lellouche, Olivier Lesur, Rick Hall and others, in addition to colleagues from the Australian and New Zealand Intensive Care Society Clinical Trials Group
(ANZICS CTG) compared the two most common prevention strategies in critically ill medical-surgical patients - the more expensive low-molecular-weight-heparin (LMWH) dalteparin and the standard unfractionated heparin (UFH).
The results of the PROTECT Trial were published in the New England Journal of Medicine. PROTECT showed that while there was no difference between the two drugs in mortality nor leg clots, patients who received LWMH had the same bleeding rates but reduced rates of clots in the lung and reduced risk of a potentially fatal drug allergy called heparin-induced thrombocytopenia (a reduced number of platelets in the blood that increases the clotting risk). You can read the article by clicking here
A recent article in the Journal of the American Medical Association by Robert Fowler
of the CCCTG and colleagues from ANZICS CTG now demonstrates the economic consequences of these two prevention strategies. The lower rates of pulmonary embolism and heparin-induced thrombocytopenia and corresponding lower overall use of resources with LMWH means that from a health care payer perspective, venous thromboembolism prophylaxis with LMWH was more effective and had similar or lower costs than the use of UFH. For example, if an ICU with 1000 medical-surgical admissions per year uses UFH instead of LMWH, the increase in cost may be between $1,000,000 and $1,500,000 per year with similar or worse clinical outcomes. In other word, this careful economic analysis showed better health outcomes and overall, lower health care costs when using LMWH for the prevention of venous thromboembolism in the ICU. You can read the article by clicking here
These 2 studies provide a clear example of the contribution of research from the CCCTG that improves the care of critically ill patients and favourably impacts on the healthcare system.