From the Guidelines
Enoxaparin Administration Timing
Enoxaparin should be given 12 hours before orthopedic surgery.
Rationale
- The American College of Chest Physicians (ACCP) guidelines suggest administering Low-Molecular-Weight Heparin (LMWH), such as enoxaparin, 12 hours before surgery for patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) 1.
- This recommendation is supported by other studies, which also suggest that LMWH can be started 12 hours before or after surgery 1.
- The Mayo Clinic Proceedings also recommends giving the first dose of LMWH at least 12 hours from the time of surgery, either pre- or postoperatively 1.
- It is essential to note that the timing of enoxaparin administration may vary depending on the individual patient's risk factors and the surgeon's preference.
- The standard dose of enoxaparin for VTE prophylaxis in orthopedic surgery patients is 30 mg twice daily, with the first dose given 12 hours before surgery 1.
- The duration of thromboprophylaxis should be at least 10 to 14 days, with consideration of up to 35 days for patients at higher risk for VTE 1.
From the Research
Enoxaparin Administration Timing
- The optimal timing for administering enoxaparin before orthopedic surgery is not universally agreed upon, but studies provide some guidance 2, 3.
- One study found that administering enoxaparin 12 hours before surgery had a similar safety and efficacy profile to administering it between 6 and 12 hours after surgery 2.
- Another study used a regimen of 60 mg enoxaparin, starting from the time of admission, which is before surgery, and found it to be safe in hip trauma surgery 3.
Comparison to Other Anticoagulants
- Fondaparinux, another anticoagulant, has been shown to be more effective than enoxaparin in preventing venous thromboembolism after orthopedic surgery, but with a higher risk of major bleeding 4.
- The American College of Chest Physicians recommends at least 7 to 10 days of prophylaxis after hip and knee replacement surgery, and extended prophylaxis may be beneficial for high-risk patients 5.