From the Guidelines
For VTE prophylaxis after BPH surgery, Lovenox (enoxaparin) is the preferred anticoagulant over Eliquis (apixaban) due to its established efficacy and safety profile in the perioperative setting. The recommended regimen is enoxaparin 40mg subcutaneously once daily, starting after surgery, as outlined in the guidelines for VTE prophylaxis in patients undergoing urologic surgery 1.
Key Considerations
- The guidelines suggest that for patients at very high risk, enoxaparin 40 mg subcutaneous daily can be used, along with an adjuvant pneumatic compression device, if the risk of bleeding is not high 1.
- It's crucial to consider individual patient factors, including bleeding risk, renal function, and mobility status, when deciding on the anticoagulant regimen.
- Mechanical prophylaxis with compression devices should be used alongside pharmacological prophylaxis when appropriate, especially in high-risk patients.
Dosing and Administration
- For patients with a body weight of 150 Kg or more, consider increasing the prophylaxis dose of enoxaparin to 40 mg subcutaneously every 12 hours 1.
- In patients with renal impairment, the dose of enoxaparin may need to be adjusted, with a recommended dose of 30 mg daily for those with a creatinine clearance of less than 30 mL/min.
Safety and Monitoring
- The risks of bleeding must be weighed against the benefits of prophylaxis, and special testing may be indicated for enoxaparin in patients with a history of heparin-induced thrombocytopenia 1.
- Enoxaparin should be avoided or held for 24 hours before planned manipulation of an epidural or spinal catheter and resumed no earlier than 2 hours after manipulation 1.
From the Research
Comparison of Lovenox and Eliquis for VTE Prophylaxis after BPH Surgery
- There are no direct studies comparing Lovenox (enoxaparin) and Eliquis (apixaban) for venous thromboembolism (VTE) prophylaxis in patients after Benign Prostatic Hyperplasia (BPH) surgery.
- However, several studies have investigated the use of enoxaparin for VTE prophylaxis in patients undergoing surgical procedures, including orthopedic surgery and radical retropubic prostatectomy 2, 3, 4, 5, 6.
Efficacy of Enoxaparin for VTE Prophylaxis
- A meta-analysis of 4 randomized double-blind studies found that fondaparinux, a synthetic selective factor Xa inhibitor, significantly reduced the incidence of VTE compared to enoxaparin in patients undergoing orthopedic surgery 2.
- A retrospective study found that enoxaparin was effective in preventing VTE in men undergoing radical retropubic prostatectomy, with a low rate of VTE (4%) 3.
- A randomized, double-blind trial found that weight-based administration of enoxaparin was superior to fixed-dose administration for avoiding overanticoagulation and underanticoagulation in postoperative patients 4.
Duration of Enoxaparin Prophylaxis
- A study found that extended duration enoxaparin decreased the rate of VTE after radical cystectomy compared to inpatient only subcutaneous heparin, with the main benefit on post-discharge VTE 5.
- Another study found that enoxaparin prophylaxis for four weeks after surgery for abdominal or pelvic cancer was safe and significantly reduced the incidence of venographically demonstrated thrombosis, as compared with enoxaparin prophylaxis for one week 6.
Limitations
- There are no studies directly comparing Lovenox and Eliquis for VTE prophylaxis in patients after BPH surgery.
- The available studies have investigated the use of enoxaparin in different surgical procedures and patient populations, which may not be directly applicable to BPH surgery.