High incidence of complications from enoxaparin treatment after arthroplasty.
Pulmonary embolism (PE) complicates 1% to 10% of total joint arthroplasties and generally requires immediate anticoagulation. Low-molecular-weight heparins have supplanted unfractionated heparin as the treatment of choice for PE and hold a 1A recommendation from the American College of Chest Physicians for this indication. However, the complications of enoxaparin treatment begun in close proximity to arthroplasty surgery are not well described. We examined the records of 135 patients who underwent total joint arthroplasty, experienced an in-hospital PE, and received treatment with enoxaparin at therapeutic doses (1 mg/kg body weight). The type and frequency of complications were determined and classified as major or minor. Twenty-seven percent of patients experienced minor complications and 10% experienced major complications. The incidence of major bleeding was substantially higher than rates reported for nonsurgical patients. The overall complication rate of enoxaparin treatment is similar to the rate of complications reported for unfractionated heparin treatment in this setting, but the complications are less severe.


METHODS
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Neviaser
Andrew S
AS
Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. neviasera@hss.edu
Chang
Charles
C
Lyman
Stephen
S
Della Valle
Alejandro Gonzales
AG
Haas
Steven B
SB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D015897:Comorbidity; D017984:Enoxaparin / Q000009:adverse effects*; D005260:Female; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007592:Joint Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D013923:Thromboembolism / Q000517:prevention & control
D000925:Anticoagulants; D017984:Enoxaparin; D006493:Heparin