Nadroparin in the Prevention of Deep Vein Thrombosis in Acute Decompensated COPD

Abstract

Low molecular weight heparins are as effective as unfractionated heparin in deep-vein thrombosis (DVT) prophylaxis for major surgery. However, there is no evidence nor consensus for prophylaxis in medical patients. We compared the efficacy and safety of nadroparin calcium (nadroparin) with placebo in medical patients at high risk of DVT. A total of 223 patients mechanically ventilated for acute, decompensated chronic obstructive pulmonary disease, were randomized to treatment with subcutaneous nadroparin adjusted for body weight (0.4 ml, i.e., 3,800 AXa IU, or 0.6 ml, i.e., 5,700 AXa IU) or placebo. The average duration of treatment was 11 d. The incidence of DVT in patients receiving nadroparin was significantly lower than that in patients receiving placebo (15.5 versus 28.2%; p = 0.045). Although the incidence of adverse events was high in both groups, there were no significant differences between nadroparin and placebo for total adverse events (46.3 versus 39.8%; p = 0.33), serious adverse events (25.0 versus 19.5%; p = 0.32), or those resulting in early permanent discontinuation of treatment (12.0 versus 8.8%; p = 0.44). The most common adverse event was hemorrhage. There was the same number of deaths in both treatment groups. Subcutaneous nadroparin resulted in 45% decrease in incidence of DVT compared with placebo.

Give your patient a fast hug (at least) once a day*

“…It has thus been recommended that all patients receive at least subcutaneous heparin, unless contraindicated (36). Several studies have been conducted comparing various heparins in specific patient groups (37)(38)(39)(40)(41), but very few have involved general ICU patients (42), and the most effective method of prophylaxis is still unclear. Clearly, the benefit of prophylaxis must be weighed against the risk of bleeding complications.…”

Epidemiology of thrombotic risk factors: The difficulty in using clinical trials to develop a risk assessment model

“…Among patients who died while in the ICU, PE was reported in 7% to 27% of postmortem examinations, and PE was thought to have caused or contributed to death in up to 12% of the patients (7)(8)(9)(10)(11). In the absence of thromboprophylaxis, the estimated rates of symptomatic and asymptomatic DVT range from 13% to 31% in critically ill patients (7), with the reported incidence being particularly high in the most recent trials (12,13).…”

Prise en charge des exacerbations aiguës de BPCO

“…L'anticoagulation par héparine non fractionnée à dose efficace n'est pas recommandée, sauf autre indication. La prophylaxie par héparines de bas poids moléculaire à posologie élevée, par voie sous-cutanée, est recommandée, comme la nardroparine 5000 UI anti-Xa ou l'énoxaparine 0,4 mL [38,39].…”