Bleeding complications with enoxaparin for deep venous thrombosis prophylaxis

Shaieb, Mark D.; Watson, Brandi N.; Atkinson, Robert E.

doi:10.1016/s0883-5403(99)90098-0

Cited by 72 publications

(40 citation statements)

References 22 publications

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“…Bleeding is more common with Group A anticoagulants. Bleeding [5,8,17,18,23,26,41,42,52,55,61] can lead to death from multiple causes, including shock, renal failure, stroke, myocardial infarction, infection, and sepsis. It is likely complications of bleeding contributed to the increased mortality.…”

Section: Discussionmentioning

confidence: 99%

Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

Sharrock

Valle

et al. 2008

Clinical Orthopaedics &Amp; Related Research

162

116

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Section: Discussionmentioning

confidence: 99%

Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

Sharrock

Valle

et al. 2008

Clinical Orthopaedics &Amp; Related Research

162

116

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“…Remarkably, increasing dosage of enoxaparin (which would correlate with increased BMI in weight-based dosing) was also not predictive of complications. Shaieb et al have reported increased complications when prophylactic enoxaparin was begun within 6 hours of surgery and when used in patients undergoing bilateral procedures [32]. Patterson et al noted a considerable increase in complications when UFH anticoagulation was begun within the first 5 postoperative days [26].…”

Section: Discussionmentioning

confidence: 99%

High Incidence of Complications From Enoxaparin Treatment After Arthroplasty

Neviaser

Chang

Lyman

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Pulmonary embolism (PE) complicates 1% to 10% of total joint arthroplasties and generally requires immediate anticoagulation. Low-molecular-weight heparins have supplanted unfractionated heparin as the treatment of choice for PE and hold a 1A recommendation from the American College of Chest Physicians for this indication. However, the complications of enoxaparin treatment begun in close proximity to arthroplasty surgery are not well described. We examined the records of 135 patients who underwent total joint arthroplasty, experienced an in-hospital PE, and received treatment with enoxaparin at therapeutic doses (1 mg/kg body weight). The type and frequency of complications were determined and classified as major or minor. Twenty-seven percent of patients experienced minor complications and 10% experienced major complications. The incidence of major bleeding was substantially higher than rates reported for nonsurgical patients. The overall complication rate of enoxaparin treatment is similar to the rate of complications reported for unfractionated heparin treatment in this setting, but the complications are less severe.

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“…Several factors might contribute to explain these high aXa levels: lower body weight, renal dysfunction, age [3,4]. These results are not Mahé/Drouet/Chassany/Grenard/Caulin/ Bergmann in accordance with the aXa measurements performed in a subset of patients included in the MEDENOX trial (n = 68): mean aXa at the end of the treatment (day 10 B 4 days) in the enoxaparin 4,000 IU group was 0.41 IU/ml with no patient with aXa above 0.5 IU/ml [10].…”

Section: Discussionmentioning

confidence: 99%

“…It is also recommended in medical high risk since the results of the MEDENOX trial, a placebo-controlled double-blind randomized trial that showed that enoxaparin 4,000 IU significantly reduced the incidence of thromboembolic events and phlebographic DVT in recently hospitalized medical patients [2]. Following the publication of several reports and surveys, the bleeding risk of prophylactic LMWH is now recognized [1,3,4]. Age has been identified as a predisposing factor of heparin-related bleeding [5,6].…”

Section: Introductionmentioning

confidence: 99%

Low Molecular Weight Heparin for the Prevention of Deep Venous Thrombosis: A Suitable Monitoring in Elderly Patients?

Mahé

Drouet

Chassany

et al. 2002

Pathophysiol Haemos Thromb

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Monitoring of anti-Xa activity (aXa) levels is not routinely required in patients receiving enoxaparine at prophylactic dosages, since aXa is supposed to stay below the manufacturer’s recommended range in patients treated for venous thrombosis (0.5–1 IU/ml). In order to aXa in elderly subjects receiving prophylactic enoxaparin, 68 consecutive patients (mean age 82.5 ± 10.7 years) hospitalized in a medical department receiving 4,000 IU enoxaparin daily subcutaneously for the prevention of venous thromboembolic disease were studied. After the first injection of enoxaparin, the aXa of 57.4% patients was superior to 0.5 IU/ml while 69.4% had an aXa higher than 0.5 after 8.4 ± 1.2 days. A negative relationship between aXa and body weight and a trend towards a positive correlation between aXa and age but not with creatinine clearance were noted. Our findings question the opportunity to monitor aXa in elderly patients receiving 4,000 IU enoxaparin as antithrombotic prophylaxis.

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Bleeding complications with enoxaparin for deep venous thrombosis prophylaxis

Cited by 72 publications

References 22 publications

Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

High Incidence of Complications From Enoxaparin Treatment After Arthroplasty

Low Molecular Weight Heparin for the Prevention of Deep Venous Thrombosis: A Suitable Monitoring in Elderly Patients?

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