https://doi.org/10.1007/s00392-025-02625-4
1LMU Klinikum der Universität München Medizinische Klinik und Poliklinik I München, Deutschland
IMPORTANCE: Venous thromboembolism (VTE) is a common complication among hospitalized patients. Low-molecular-weight-heparin (LMWH) is recommended for thromboprophylaxis, but its benefits in non-surgical patients, particularly those receiving dual antiplatelet therapy (DAPT), remain unclear. There is currently no evidence providing insights into the risks and benefits of LMWH thromboprophylaxis in patients on DAPT.
OBJECTIVE: To determine the thromboprophylactic effect and bleeding risk of LMWH thromboprophylaxis among non-surgical hospitalized patients on DAPT.
DESIGN: Dual center cohort study.
SETTING: Cardiology departments of two tertiary referral hospitals of the LMU University Munich.
PARTICIPANTS: Patients hospitalized from May 2015 to April 2023 and receiving DAPT, defined as treatment with aspirin and a P2Y12 inhibitor, were analyzed. Patients receiving ≥ 1 day of full dose anticoagulation were excluded.
EXPOSURE: DAPT with or without LMWH thromboprophylaxis.
MAIN OUTCOME MEASURES: The primary endpoint was the incidence of VTE during hospitalization, confirmed through imaging techniques. In a subgroup of patients, need for erythrocyte transfusion was analyzed as a safety endpoint.
RESULTS: A total of 8,567 patients receiving DAPT were included, of which 2,346 were receiving LMWH prophylaxis. The incidence of VTE was very low and did not differ between the LMWH and non-LMWH groups (0.04% vs. 0%, p=0.27). Subgroup analysis revealed higher bleeding rates as mirrored by more erythrocyte transfusions in the LMWH group (9.4 vs. 5.2%, p=0.002) that persisted after propensity score matching.
CONCLUSION: In patients receiving DAPT, LMWH thromboprophylaxis was associated with a comparably low incidence of VTE but a higher rate of erythrocyte transfusions in subgroup analysis.