Michael Jacobson, MD, MPH
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Jacobson M. Prevention of Venous Thrombosis in Knee Arthroplasty. Ann Intern Med. 1997;126:173. doi: 10.7326/0003-4819-126-2-199701150-00019
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Published: Ann Intern Med. 1997;126(2):173.
TO THE EDITOR:
In a randomized trial , Leclerc and colleagues compared postoperative, fixed-dose enoxaparin (a low-molecular-weight heparin) with adjusted-dose warfarin for the prevention of venous thromboembolism after knee arthroplasty. Enoxaparin was more effective in preventing deep venous thrombosis, as detected by venography. However, no statistically significant difference was seen between the two treatments in the incidence of proximal deep venous thrombosis or major bleeding.
The study design was biased in favor of enoxaparin. Therapy with oral warfarin was begun on the evening after surgery; therapy with subcutaneous enoxaparin was started on the morning after. Although low-molecular-weight heparin therapy was initiated some 12 hours later than warfarin, the normal delay in onset of warfarin action is such that the drug would not become therapeutic until well after enoxaparin had reached effective levels.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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