From the Guidelines
For DVT prophylaxis after hip arthroplasty, enoxaparin 30 mg subcutaneously twice daily is recommended, starting 12 hours before or after surgery and continuing for 10-14 days, with consideration to extend up to 35 days. This recommendation is based on the guidelines outlined in the study published in the Mayo Clinic Proceedings 1. The study provides a comprehensive review of VTE prevention and management guidelines, including specific recommendations for patients undergoing orthopedic surgery such as total hip arthroplasty (THA).
Some key points to consider when selecting a prophylaxis strategy include:
- The use of enoxaparin, which has been shown to be effective in preventing DVT in patients undergoing THA 1
- The importance of starting prophylaxis 12 hours before or after surgery, and continuing for an extended period of time (10-14 days, with consideration to extend up to 35 days) 1
- The option to use alternative prophylaxis strategies, such as dalteparin, fondaparinux, or rivaroxaban, although enoxaparin is specifically recommended for patients undergoing THA 1
- The need to consider the patient's individual risk factors and medical history when selecting a prophylaxis strategy, as well as the potential for extended prophylaxis to reduce the risk of DVT.
It is essential to note that the risk of DVT remains elevated for several weeks after hip replacement, and extended prophylaxis is necessary to minimize this risk. Additionally, early mobilization and mechanical prophylaxis with intermittent pneumatic compression devices should be used in addition to pharmacological methods, especially when medication is delayed or contraindicated.
From the FDA Drug Label
In patients undergoing hip fracture, hip replacement, or knee replacement surgery, the recommended dose of fondaparinux sodium injection is 2.5 mg administered by subcutaneous injection once daily after hemostasis has been established. Administer the initial dose no earlier than 6 to 8 hours after surgery. The recommended dose for Deep Vein Thrombosis (DVT) prophylaxis after hip arthroplasty is 2.5 mg of fondaparinux sodium injection administered by subcutaneous injection once daily, starting no earlier than 6 to 8 hours after surgery 2.
- The usual duration of therapy is 5 to 9 days.
- Administration of fondaparinux sodium injection earlier than 6 hours after surgery increases the risk of major bleeding.
From the Research
Recommended Dose for DVT Prophylaxis
The recommended dose for Deep Vein Thrombosis (DVT) prophylaxis after hip arthroplasty varies depending on the medication used.
- Enoxaparin can be administered at a dose of 30mg twice daily, initiated postoperatively, or 40mg once daily, starting preoperatively 3.
- Rivaroxaban can be administered at a dose of 10mg once daily, beginning after surgery 4.
- Fondaparinux can be administered at a dose of 2.5mg given at least 6 hours postoperatively 5.
- Warfarin can be administered at an adjusted dose to achieve a target international normalized ratio (INR) 6.
- A dose of 60mg enoxaparin daily, in split doses, starting before surgery, has also been shown to be safe and effective in patients with hip fractures 7.
Comparison of Medications
The choice of medication for DVT prophylaxis after hip arthroplasty depends on various factors, including the patient's risk factors, medical history, and potential interactions with other medications.
- Enoxaparin has been shown to be effective in preventing DVT, with a lower risk of major bleeding compared to unfractionated heparin 3.
- Rivaroxaban has been shown to be more effective than enoxaparin in preventing DVT, with a similar safety profile 4.
- Fondaparinux has been shown to be more effective than enoxaparin in preventing DVT, with a similar safety profile 5.
- Warfarin has been shown to be effective in preventing DVT, but requires regular monitoring of INR levels to ensure therapeutic efficacy and minimize the risk of bleeding 6.