The Perioperative Management of Antithrombotic Therapies Using Enoxaparin

Abstract

Oral anticoagulant therapy is frequently and increasingly prescribed for patients at risk of arterial or venous thromboembolism (VTE). Although elective surgical or invasive procedures have necessitated temporary interruption of anticoagulants, managing these patients has been performed empirically and been poorly investigated. This study was designed to evaluate the adequacy of perioperative anticoagulation using enoxaparin. This was a retrospective, single-center study that evaluated the efficacy and safety of therapeutic-dose enoxaparin for bridging therapy in patients on long-term warfarin at Soonchunhyang University Hospital in Korea between August 2009 and July 2011. Warfarin was discontinued 5 days before surgery, and enoxaparin was administered twice daily by subcutaneous injection at a dose of 1 mg per kg from 3 days before the procedure to the last dose 24 hours before the procedure. Anticoagulation was restarted if proper hemostasis had been confirmed. There were 49 patients, of whom 25 (51%) were men, and the mean age was 63 years. Thirty-four (69%) received warfarin therapy for VTE, and 9 (18%) for atrial fibrillation. Twenty-nine patients (59%) underwent major surgery and 20 (41%) minor surgery. The mean postoperative duration of enoxaparin was 4 days. No patients had thromboembolic complications through 30 days after the procedure. The overall 30-day mortality rate was 0%. In conclusion, our findings demonstrate that bridging therapy with therapeutic-dose enoxaparin is feasible and associated with a low incidence of major bleeding and no thromboembolic complications. However, the optimal approach to managing patients perioperatively is uncertain and requires further evaluation.

Thromboembolic complications in newborns – diagnostic value of D-dimers concentration and proposed outline of enoxaparin use

“…Due to the risk of intramedullary haematoma (IMH), it is contraindicated to perform LP in a period shorter than 12 hours from the administration of the prophylactic dose of EX, and in the period shorter than 24 hours from the administration of the therapeutic EX dose [88,89]. Based on the benefit-risk assessment, consideration should be given to not using EX for at least 6 hours after LP [90].…”

Management of Women with Antiphospholipid Antibodies or Antiphospholipid Syndrome during Pregnancy

“… 12 44 In a retrospective study, therapeutic dose of enoxaparin with the last dose 24 hours before the surgery, no patients had thromboembolic complications through 30 days after the procedure. 45 Patients receiving therapeutic doses of LMWH should be switched to unfractionated heparin, which has a shorter half-life, at weeks 36–37 of gestation. However, LMWH can be continued until 38 or 39 weeks in patients regarded as being at very low risk of unpredictable preterm delivery.…”

Postoperative Retroperitoneal Hematoma Associated With Enoxaparin

“…In 2017, a study evaluating the perioperative venous thromboembolism prophylaxis found a 4.1% major bleeding risk when using enoxaparin. 2 The literature is scarce on enoxaparin and retroperitoneal bleeding in the surgical population. Many of the patients who experience this complication are not surgical patients, but rather medicine patients receiving the medication for various ailments.…”

“…In 2017, a study evaluating the perioperative venous thromboembolism prophylaxis found a 4.1% major bleeding risk when using enoxaparin. 2…”