Low molecular weight heparin dosing regimens after total joint arthroplasty: a prospective, single-center, randomized, double-blind study
Abstract Background Low molecular weight heparin (LMWH) has been the standard treatment for preventing venous thromboembolism after total joint arthroplasty. However, the evidence supporting specific LMWH dosing regimens is limited. Objectives This study assessed the efficacy and safety of three eno...
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BMC
2024-11-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-024-05303-9 |
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| author | Jingjing Shang Liangliang Wang Jinhong Gong Xinru Liu Dan Su Xindie Zhou Yuji Wang |
| author_facet | Jingjing Shang Liangliang Wang Jinhong Gong Xinru Liu Dan Su Xindie Zhou Yuji Wang |
| author_sort | Jingjing Shang |
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| description | Abstract Background Low molecular weight heparin (LMWH) has been the standard treatment for preventing venous thromboembolism after total joint arthroplasty. However, the evidence supporting specific LMWH dosing regimens is limited. Objectives This study assessed the efficacy and safety of three enoxaparin dosing regimens to prevent venous thromboembolism. Methods Participants undergoing hip or knee replacement were randomly assigned to receive 20 mg of enoxaparin 6 h postoperatively (Group A), 40 mg 6 h postoperatively (Group B), or 40 mg 12 h postoperatively (Group C). The primary outcomes included thromboembolic and major bleeding events within 3 months, while the secondary outcomes comprised ecchymosis, wound exudation, drainage volume, allogeneic red blood cell transfusion, and first postoperative day hemoglobin levels. Results A total of 536 patients were analyzed. The occurrence of thromboembolic events was comparably low across all groups. Group C exhibited the lowest postoperative ecchymosis rate at 19.3%, significantly less than Group A (32.8%, p = 0.004) and Group B (37.7%, p < 0.001). Ecchymosis rates were about double in Group A and 1.5 times higher in Group B compared to Group C. Significant differences were also observed in 24-hour and total postoperative drainage volumes, with Group B having higher volumes than the other groups. Clinical trial registration This trial was prospectively registered at the China Clinical Trials Registry (registration date: November 14, 2021; registration number: ChiCTR2100053191). Conclusion No significant differences in venous thromboembolism rates were seen between the tested enoxaparin dosing regimens after total joint arthroplasty. The 40 mg dose administered 12 h after surgery was associated with reduced postoperative ecchymosis and drainage volumes without an increased thrombosis risk, suggesting it is a safer and more effective option than earlier or lower dosages. Graphical Abstract |
| format | Article |
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| institution | Kabale University |
| issn | 1749-799X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-6baa6340e43a4b0984438ea264d935c12024-12-01T12:36:47ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2024-11-0119111110.1186/s13018-024-05303-9Low molecular weight heparin dosing regimens after total joint arthroplasty: a prospective, single-center, randomized, double-blind studyJingjing Shang0Liangliang Wang1Jinhong Gong2Xinru Liu3Dan Su4Xindie Zhou5Yuji Wang6Department of Pharmacy, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical UniversityDepartment of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical UniversityDepartment of Pharmacy, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical UniversityDepartment of Pharmacy, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical UniversityDepartment of Pharmacy, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical UniversityDepartment of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical UniversityDepartment of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical UniversityAbstract Background Low molecular weight heparin (LMWH) has been the standard treatment for preventing venous thromboembolism after total joint arthroplasty. However, the evidence supporting specific LMWH dosing regimens is limited. Objectives This study assessed the efficacy and safety of three enoxaparin dosing regimens to prevent venous thromboembolism. Methods Participants undergoing hip or knee replacement were randomly assigned to receive 20 mg of enoxaparin 6 h postoperatively (Group A), 40 mg 6 h postoperatively (Group B), or 40 mg 12 h postoperatively (Group C). The primary outcomes included thromboembolic and major bleeding events within 3 months, while the secondary outcomes comprised ecchymosis, wound exudation, drainage volume, allogeneic red blood cell transfusion, and first postoperative day hemoglobin levels. Results A total of 536 patients were analyzed. The occurrence of thromboembolic events was comparably low across all groups. Group C exhibited the lowest postoperative ecchymosis rate at 19.3%, significantly less than Group A (32.8%, p = 0.004) and Group B (37.7%, p < 0.001). Ecchymosis rates were about double in Group A and 1.5 times higher in Group B compared to Group C. Significant differences were also observed in 24-hour and total postoperative drainage volumes, with Group B having higher volumes than the other groups. Clinical trial registration This trial was prospectively registered at the China Clinical Trials Registry (registration date: November 14, 2021; registration number: ChiCTR2100053191). Conclusion No significant differences in venous thromboembolism rates were seen between the tested enoxaparin dosing regimens after total joint arthroplasty. The 40 mg dose administered 12 h after surgery was associated with reduced postoperative ecchymosis and drainage volumes without an increased thrombosis risk, suggesting it is a safer and more effective option than earlier or lower dosages. Graphical Abstracthttps://doi.org/10.1186/s13018-024-05303-9Low molecular weight heparinDosing regimensTotal joint arthroplastyVenous thromboembolism prophylaxisEcchymosisDrainage volume |
| spellingShingle | Jingjing Shang Liangliang Wang Jinhong Gong Xinru Liu Dan Su Xindie Zhou Yuji Wang Low molecular weight heparin dosing regimens after total joint arthroplasty: a prospective, single-center, randomized, double-blind study Journal of Orthopaedic Surgery and Research Low molecular weight heparin Dosing regimens Total joint arthroplasty Venous thromboembolism prophylaxis Ecchymosis Drainage volume |
| title | Low molecular weight heparin dosing regimens after total joint arthroplasty: a prospective, single-center, randomized, double-blind study |
| title_full | Low molecular weight heparin dosing regimens after total joint arthroplasty: a prospective, single-center, randomized, double-blind study |
| title_fullStr | Low molecular weight heparin dosing regimens after total joint arthroplasty: a prospective, single-center, randomized, double-blind study |
| title_full_unstemmed | Low molecular weight heparin dosing regimens after total joint arthroplasty: a prospective, single-center, randomized, double-blind study |
| title_short | Low molecular weight heparin dosing regimens after total joint arthroplasty: a prospective, single-center, randomized, double-blind study |
| title_sort | low molecular weight heparin dosing regimens after total joint arthroplasty a prospective single center randomized double blind study |
| topic | Low molecular weight heparin Dosing regimens Total joint arthroplasty Venous thromboembolism prophylaxis Ecchymosis Drainage volume |
| url | https://doi.org/10.1186/s13018-024-05303-9 |
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