Comparison of Enoxaparin and Warfarin for the Prevention of Venous Thromboembolic Disease After Total Hip Arthroplasty. Evaluation During Hospitalization and Three Months After Discharge*

Abstract

Background: Venous thromboembolic disease in the form of deep venous thrombosis and pulmonary embolism is a major risk after a total hip arthroplasty. Enoxaparin, a low-molecular-weight heparin, has been shown to reduce the prevalence of deep venous thrombosis after total hip arthroplasty. Warfarin, an orally administered anticoagulant, has been used historically to reduce the risk of deep venous thrombosis after total hip arthroplasty. Methods: We compared enoxaparin and adjusteddose warfarin with respect to their safety and their efficacy in the prevention of clinically important venous thromboembolic disease, defined as distal or proximal deep venous thrombosis or pulmonary embolism, or both, during hospitalization after total hip arthroplasty. We also evaluated the prevalence of complications and mortality from venous thromboembolic disease within three months after discharge. Results: Three thousand and eleven patients at 156 centers were randomly assigned to prophylactic treatment with injection of enoxaparin or oral administration of adjusted-dose warfarin during hospitalization. During the study, fifty-five (3.6 percent) of the 1516 patients who were managed with enoxaparin and fifty-six (3.7 percent) of the 1495 patients who were managed with warfarin had venous thromboembolic gene, Oregon 97401.

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

“…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.…”

“…Patients in Groups A (potent anticoagulants) and C (warfarin) did not receive pneumatic compression or aspirin after surgery. In five of the publications [8,14,34,37,49], the type of anesthetic was not specified for Group A (potent anticoagulants) or C (warfarin). In publications in which anesthesia was identified, 36% (3785 of 10,437) of patients in Group A (potent anticoagulants) and 29% (397 of 1342) of patients in Group C (warfarin) received spinal or epidural anesthesia.…”

Prevention of Venous Thromboembolism in Surgical Patients

“…40 -44 These studies showed that in comparison with vitamin K 45 The rate of VTE was 0.3% in patients receiving LMWH compared with 1.1% in those receiving warfarin, a statistically significant reduction. However, major bleeding occurred in 0.6% of the enoxaparin patients compared with 0.3% of the warfarin group.…”

Elevation in D-Dimer Levels after the Surgical Treatment of Stage IA Extramammary Paget’s Disease: A Risk of Deep Vein Thrombosis

“…It often occurs in patients undergoing total hip replacement, and studies have been conducted to elucidate the relationship between DVT and total hip replacement [1][2][3]. The levels of D-dimer, a highly sensitive marker of venous thromboembolism, have been studied among these patients to measure the risk of DVT [4][5][6].…”