title: Enoxaparin and Warfarin for Venous Thromboembolism Prophylaxis in Total Hip Arthroplasty: To Bridge or Not to Bridge?
abstract: Anticoagulation bridges consisting of subcutaneous enoxaparin combined with oral-dosed warfarin are commonly used in orthopedic procedures as chemoprophylaxis against thromboembolic disease. For some patients, these bridges result in complications. One hundred twenty-one patients were evaluated after primary total hip arthroplasty (THA) between 2008 and 2009. Sixty-three patients were given bridged therapy after THA, and 58 were given warfarin only. The 2 groups were statistically matched on various comorbidities. Outcomes of interest were number of days to dry wound and length of hospital stay. Wounds of patients given anticoagulation bridges took longer to heal than wounds of patients given warfarin only (odds ratio, 2.39; P < .05). In addition, patients given anticoagulation bridges had longer hospital stays (odds ratio, 1.27; P < .05). Compared with warfarin-only therapy after THA, use of warfarin bridged with enoxaparin increased the risk for prolonged wound healing and subsequent infection. In addition, bridged therapy cost $2000 more per patient than warfarin-only therapy. Further studies should examine the risks and benefits of these bridges in reducing thromboembolic disease.
authors.affiliation: Southern California Permanente Medical Group, Kaiser Permanente, Fontana, CA. Matthew.t.Kleiner@kp.org.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Kleiner
authors.forename: Awad A
authors.initials: AA
authors.lastname: Ahmed
authors.forename: Aaron
authors.initials: A
authors.lastname: Huser
authors.forename: Pekka
authors.initials: P
authors.lastname: Mooar
authors.forename: Joseph
authors.initials: J
authors.lastname: Torg
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D014859:Warfarin