title: Evaluation of the safety and efficacy of enoxaparin and warfarin for prevention of deep vein thrombosis after total knee arthroplasty.
abstract: Of 263 patients who underwent total knee arthroplasty, 122 received adjusted low-dose warfarin and 141 received enoxaparin as deep vein thrombosis (DVT) prophylaxis. Three patients in the warfarin group and 3 in the enoxaparin group developed ultrasound-detectable DVT (P > .05). Although the amount of perioperative blood transfused was equivalent in both groups, the overall hemoglobin drop was greater (P < .005) in the enoxaparin group (2.9 g/dL) as compared with the warfarin group (2.3 g/dL). Five patients (4.6%) in the warfarin group and 16 (11.3%) in the enoxaparin group had bleeding complications (P < .05). Our data support earlier published reports suggesting that reductions, if any, in the incidence of DVT associated with enoxaparin are offset by a significant increase in bleeding complications as compared with adjusted-dose warfarin. We continue to use adjusted-dose warfarin as primary thromboembolic prophylaxis after total knee arthroplasty.
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University Medical School, Chicago, Illinois, USA.
authors.forename: S H
authors.initials: SH
authors.lastname: Stern
authors.forename: R L
authors.initials: RL
authors.lastname: Wixson
authors.forename: D
authors.initials: D
authors.lastname: O'Connor
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee; D016022:Case-Control Studies; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D014859:Warfarin