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High Incidence of Complications From Enoxaparin Treatment After Arthroplasty

  • Symposium: Papers Presented at the Annual Meetings of the Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Brett Lenart, MD, and Michael Loeven, BS, for their assistance with data collection.

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Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Andrew S. Neviaser MD, Stephen Lyman PhD, Alejandro Gonzales Della Valle MD & Steven B. Haas MD

  2. Weill Cornell Medical College, New York, NY, USA

    Charles Chang MD

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  1. Andrew S. Neviaser MD
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  2. Charles Chang MD
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  3. Stephen Lyman PhD
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  4. Alejandro Gonzales Della Valle MD
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  5. Steven B. Haas MD
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Correspondence to Andrew S. Neviaser MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Hospital for Special Surgery.

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Neviaser, A.S., Chang, C., Lyman, S. et al. High Incidence of Complications From Enoxaparin Treatment After Arthroplasty. Clin Orthop Relat Res 468, 115–119 (2010). https://doi.org/10.1007/s11999-009-1020-6

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  • DOI: https://doi.org/10.1007/s11999-009-1020-6

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