The Impact of Once- versus Twice-Daily Enoxaparin Prophylaxis on Risk for Venous Thromboembolism and Clinically Relevant Bleeding

Abstract

Background: Venous thromboembolism is a life- or limb-threatening complication that occurs in plastic surgery patients. At present, the optimal dose of enoxaparin that balances the risk of venous thromboembolism and the risk of medication-related adverse drug events—specifically, bleeding—remains unknown. Methods: This study compared pharmacodynamic and clinical outcomes, including 90-day venous thromboembolism and 90-day clinically relevant bleeding, between two prospectively performed clinical trials whose sole difference was postoperative anticoagulation strategy. Patients in trial 1 received enoxaparin 40 mg once daily for the duration of inpatient stay, and patients in trial 2 received enoxaparin 40 mg twice daily for the duration of inpatient stay. The study also examined the potential impact of a weight-based twice-daily prophylaxis strategy to achieve in-range anti–factor Xa levels. Results: The study compared 94 patients who received once-daily enoxaparin to 118 patients who received twice-daily enoxaparin. Twice-daily enoxaparin was associated with a significant decrease in 90-day acute venous thromboembolism (0 percent versus 5.3 percent; p = 0.012) and a nonsignificant increase in 90-day clinically relevant bleeding (6.8 percent versus 3.2 percent; p = 0.25). Twice-daily enoxaparin at 0.4 to 0.5 mg/kg may allow an increased proportion of patients to avoid both inadequate anticoagulation and overanticoagulation, based on anti–factor Xa levels. Conclusions: Twice-daily enoxaparin is superior to once-daily enoxaparin for 90-day acute venous thromboembolism risk reduction. Twice-daily enoxaparin may increase clinically relevant bleeding, although observed differences in this study were not significant. Weight-based twice-daily enoxaparin dosing may optimize the risks and benefits of prophylactic anticoagulation after plastic and reconstructive surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Release Characteristics of Enoxaparin Sodium Loaded Polymethylmethacrylate Bone Cement

“…Compared with ordinary heparin, enoxaparin has a strong antithrombotic effect, weak anticoagulant effect, low incidence of side effects such as bleeding, good absorption of subcutaneous injection, long biological half-life and predictable anticoagulant effect. At present enoxaparin has replaced the ordinary heparin in clinical practice [15][16][17][18] . Enoxaparin sodium has an average molecular weight of 3800-5000, anti-FXa activity of 90 IU/mg-125 IU/mg, anti-FIIa activity of 20 IU/mg-35 IU/mg, anti-FXa/anti-FIIa ratio of 3.3-5.3, and an excellent water solubility [19] .…”

The Expanding Role of Diagnostic Ultrasound in Plastic Surgery

“… 55 To reduce the frequency of this postoperative condition, prophylactic anticoagulation (ie, chemoprophylaxis) has been recommended for patients deemed to be at high risk. 56 – 59 The author has challenged the efficacy and safety of chemoprophylaxis. 60 – 64 Despite efforts to accurately predict which patients will develop a DVT after surgery, 57 , 59 this goal remains elusive.…”

“… 56 – 59 The author has challenged the efficacy and safety of chemoprophylaxis. 60 – 64 Despite efforts to accurately predict which patients will develop a DVT after surgery, 57 , 59 this goal remains elusive. 60 – 64 …”

Ethical Concerns Regarding High-Dose Enoxaparin for Venous Thromboembolism Prevention in Plastic Surgery Patients

“…A dosing schedule of 40 mg bid, double the usual prophylactic dose, produces a 6.8% rate of clinically relevant bleeding. 6…”