{"id":7051,"date":"2011-03-22T11:28:59","date_gmt":"2011-03-22T15:28:59","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?p=7051"},"modified":"2011-07-19T17:44:30","modified_gmt":"2011-07-19T21:44:30","slug":"protect-compares-unfractionated-heparin-and-dalteparin-in-critically-ill-patients","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/03\/22\/protect-compares-unfractionated-heparin-and-dalteparin-in-critically-ill-patients\/","title":{"rendered":"PROTECT Compares Unfractionated Heparin And Dalteparin In Critically Ill Patients"},"content":{"rendered":"<p>ICU patients are at high risk to develop venous thromboembolism. <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1014475\">Published in <em>NEJM<\/em><\/a>, PROTECT  (the Prophylaxis for Thromboembolism in Critical  Care Trial) compared  the effects of the low-molecular-weight heparin dalteparin with  unfractionated heparin (UFH) in 3746 critically ill patients.<\/p>\n<p>There was no significant difference between the two groups in the   primary outcome of the trial. Proximal leg deep-vein thrombosis occurred  in 5.1% of  dalteparin-treated patients and 5.8% of UFH-treated  patients  (dalteparin HR 0.92; CI 0.68-1.23, p=0.57). However, an  important secondary endpoint, pulmonary embolism, was significantly  lower in the dalteparin group than in the UFH group (1.3%  versus 2.3%,  HR 0.51, CI 0.30-0.88, p=0.01). There were no significant differences  between the groups in the incidence of major bleeding or hospital  deaths.<\/p>\n<p>The authors discussed possible reasons for the positive finding for  dalteparin in reducing\u00a0 pulmonary embolism: &#8220;Possible  explanations include embolism from other sites (e.g., upper  limbs,  pelvis, or distal leg, for which we did not screen), an effect  of  dalteparin on the propensity of leg thrombi to embolize, new-onset   thrombus formation in pulmonary arteries during critical illness, and   insensitivity or nonspecificity of proximal ultrasonography in   asymptomatic patients.&#8221;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>ICU patients are at high risk to develop venous thromboembolism. Published in NEJM, PROTECT (the Prophylaxis for Thromboembolism in Critical Care Trial) compared the effects of the low-molecular-weight heparin dalteparin with unfractionated heparin (UFH) in 3746 critically ill patients. There was no significant difference between the two groups in the primary outcome of the trial. [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,7],"tags":[745,348,746],"class_list":["post-7051","post","type-post","status-publish","format-standard","hentry","category-general","category-prevention","tag-dalteparin","tag-heparin","tag-venous-thromboli"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/7051","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=7051"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/7051\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=7051"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=7051"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=7051"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}