Heparin prophylaxis had no significant impact on mortality rates in medical patients, according to a new report in Annals of Internal Medicine. And one of the authors suggests that the results should push hospitalists to use a more critical eye when considering pharmacological prophylaxis.
"Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients and Those With Stroke: A Background Review for an American College of Physicians Clinical Practice Guideline" showed that in medical patients, heparin prophylaxis had no "statistically significant effect on any outcome in patients with acute stroke except for an increase in major bleeding events" (OR, 1.66 [CI, 1.20 to 2.28]). The authors concluded that precautionary use of heparin might have reduced pulmonary embolisms in both medical and stroke patients, but combined with upticks in bleeding and major bleeding events, the overall outcome results "in little or no net benefit."
"Our results do not really decide the issue for a physician and a patient whether prophylaxis should be used but rather show that this is a question that is still very much up in the air," says author Frank Lederle, MD, professor of medicine at the Minneapolis VA Medical Center. "That there may be good reasons to use prophylaxis, but it certainly shouldn't be something we're mandating or trying to achieve uniformity on when we don't have the evidence to do so."
Dr. Lederle adds that while some researchers are publishing papers on how well hospitalists and other physicians adhere to prophylactic procedures, he'd like to see more evidence-based analysis of the tactic's efficacy.
"The reason that this is not universally accepted by physicians is that people are aware that the data aren't that supportive of it," he says. "And that, really, the question should go back to 'Does it work and in whom does it work?' not 'Why are physicians failing to follow a guideline?'"