title: A prospective observational study on the effectiveness and safety of bemiparin, first dose administered 6 h after knee or hip replacement surgery.
abstract: BACKGROUND
  Bemiparin has shown to be effective and safe in clinical trials in total knee or hip replacement.
  
  
  METHODS
  We conducted a prospective, open, multicentre, uncontrolled study to audit the utilisation patterns of bemiparin 3,500 IU/day, first dose administered 6 h after surgery, in 1,009 patients undergoing total hip or knee replacement surgery in standard clinical practice. We analysed rates of documented symptomatic venous thromboembolism (VTE) [deep-vein thrombosis (DVT) and pulmonary embolism (PE)] confirmed by objective methods, major bleeding, death, thrombocytopaenia and other adverse events up to 6 weeks.
  
  
  RESULTS
  Rate of documented symptomatic DVT was 0.3% (95% CI, 0.1-0.9%). No cases of documented PE were reported. There were 14 (1.4%) major bleedings (95% CI, 0.8-2.3%). Neuraxial anaesthesia was used in 937 (92.9%) patients. There were no cases of spinal haematoma, fatal bleeding or bleeding in critical organs. There were 6 (0.6%) cases of mild thrombocytopaenia, which did not require treatment discontinuation. No cases of severe type II heparin-induced thrombocytopaenia were observed. There were no deaths during bemiparin prophylaxis. The median length of hospitalisation was 9 days and 92.5% of patients continued prophylaxis post-hospitalisation for a total median time of 38 days. There were no thromboembolic or bleeding complications during post-hospitalisation prophylaxis. Postoperative start of prophylaxis with bemiparin permitted that 29.3% of patients could be admitted to hospital the same day of the intervention.
  
  
  CONCLUSIONS
  Bemiparin prophylaxis, started 6 h after surgery and given for 5-6 weeks after total hip or knee replacement, was associated with low rates of VTE, major bleeding and other adverse events in normal clinical practice. Bemiparin thromboprophylaxis started 6 h after surgery makes neuraxial anaesthesia/analgesia procedures easier, without compromising efficacy.
authors.affiliation: Department of Orthopaedic Surgery and Trauma, Carlos Haya Hospital, Avda. Carlos Haya, s/n, Malaga 29010, Spain. j.ignacioabad@terra.es
authors.forename: J Ignacio
authors.initials: JI
authors.lastname: Abad
authors.forename: Antonio
authors.initials: A
authors.lastname: Gómez-Outes
authors.forename: Javier
authors.initials: J
authors.lastname: Martínez-González
authors.forename: Eduardo
authors.initials: E
authors.lastname: Rocha
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D004334:Drug Administration Schedule; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007279:Injections, Subcutaneous; D007902:Length of Stay; D008297:Male; D011182:Postoperative Care; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000517:prevention & control*; D013921:Thrombocytopenia / Q000209:etiology; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; C411345:bemiparin