The Impact of Once- versus Twice-Daily Enoxaparin Prophylaxis on Risk for Venous Thromboembolism and Clinically Relevant Bleeding
| Autor: | Kory I. Fleming, Christopher J. Pannucci, Arash Momeni, Jayant P. Agarwal, Ann Marie Prazak, W. Bradford Rockwell |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Reconstructive surgery medicine.medical_specialty Adolescent Aftercare Postoperative Hemorrhage 030230 surgery Drug Administration Schedule Young Adult 03 medical and health sciences 0302 clinical medicine medicine Humans Dosing Enoxaparin Young adult Aged Aged 80 and over business.industry Anticoagulants Venous Thromboembolism Middle Aged Plastic Surgery Procedures Clinical trial Plastic surgery Treatment Outcome 030220 oncology & carcinogenesis Anesthesia Pharmacodynamics Female Surgery business Complication Venous thromboembolism |
| Zdroj: | Plastic and Reconstructive Surgery. 142:239-249 |
| ISSN: | 0032-1052 |
| DOI: | 10.1097/prs.0000000000004517 |
| Popis: | Background Venous thromboembolism is a life- or limb-threatening complication that occurs in plastic surgery patients. At present, the optimal dose of enoxaparin that balances the risk of venous thromboembolism and the risk of medication-related adverse drug events-specifically, bleeding-remains unknown. Methods This study compared pharmacodynamic and clinical outcomes, including 90-day venous thromboembolism and 90-day clinically relevant bleeding, between two prospectively performed clinical trials whose sole difference was postoperative anticoagulation strategy. Patients in trial 1 received enoxaparin 40 mg once daily for the duration of inpatient stay, and patients in trial 2 received enoxaparin 40 mg twice daily for the duration of inpatient stay. The study also examined the potential impact of a weight-based twice-daily prophylaxis strategy to achieve in-range anti-factor Xa levels. Results The study compared 94 patients who received once-daily enoxaparin to 118 patients who received twice-daily enoxaparin. Twice-daily enoxaparin was associated with a significant decrease in 90-day acute venous thromboembolism (0 percent versus 5.3 percent; p = 0.012) and a nonsignificant increase in 90-day clinically relevant bleeding (6.8 percent versus 3.2 percent; p = 0.25). Twice-daily enoxaparin at 0.4 to 0.5 mg/kg may allow an increased proportion of patients to avoid both inadequate anticoagulation and overanticoagulation, based on anti-factor Xa levels. Conclusions Twice-daily enoxaparin is superior to once-daily enoxaparin for 90-day acute venous thromboembolism risk reduction. Twice-daily enoxaparin may increase clinically relevant bleeding, although observed differences in this study were not significant. Weight-based twice-daily enoxaparin dosing may optimize the risks and benefits of prophylactic anticoagulation after plastic and reconstructive surgery. Clinical question/level of evidence Therapeutic, II. |
| Databáze: | OpenAIRE |
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