Efficacy and safety of a perioperative enoxaparin regimen in total hip replacement under various anesthesias

Abstract

Four trials in which enoxaparin, a low-molecular-weight heparin, was used in patients having hip surgery are reported. In the first two trials, enoxaparin was given before general anesthesia. The protocol consisted of 40 mg of enoxaparin, 4,000 anti-factor Xa IU, subcutaneously 12 hours before surgery, followed by the same dose 12 hours after surgery and then once daily. In the third trial, this protocol was compared with unfractionated heparin calcium given in a standardized manner and appeared to be significantly superior both in efficacy and tolerance. In the fourth trial, the protocol was adapted for use in spinal subarachnoidal anesthesia; 20 mg of enoxaparin, 2,000 anti-factor Xa IU, was given subcutaneously 1 hour after anesthesia and 40 mg 12 hours later. In all these trials tolerance was good. Excessive bleeding did not occur with the 40 mg once daily regimen. Efficacy was good and compared favorably with other protocols in use.