PURPOSE: Assess the bleeding and thromboembolic risk of persons who underwent surgery or procedure using a scoring protocol for enoxaparin for procedures with either 1mg/kg BID or 1.5mg/kg once a day.
METHODS: Patients enrolled in our anticoagulation protocol using LMWH for bridging in patients with an intermediate to high risk of thromboembolization as determined by our thrombosis risk score from September 2007 to February 2008. This will be a retrospective cohort study examining the incidence of complications using an outpatient protocol for anti-coagulation bridging at 7 and 30 days.
RESULTS: The patient consisted of 52% female and 48% male with age range from 41 to 89 years. Diagnosis treated included atrial fibrillation in 32%, prosthetic valve in 24%, recurrent thromboembolism in 19% and miscellaneous in 25%. 37 procedures were scheduled for enoxaparin bridging. 5 of the 37 procedures were bridged with 1mg/kg enoxaparin BID and 32 of the 37 were bridged with enoxaparin 1.5mg/kg daily at the discretion of the provider. During the 7 and 30 day follow up there were no thromboembolic complications reported in of our patients. There were no major episodes of bleeding defined by significant drop in hemoglobin or need for transfusion. During 7 day follow up period there was one minor bleed reported in the 1.5mg/kg group that did not require transfusion or significant drop in hemoglobin.
CONCLUSION: Moderate to high risk patients for thromboembolic events had no thromboembolic complications when using our outpatient enoxaparin protocol. There were also no significant bleeds when using or protocol. Once a day enoxaparin dosing is effective and safe in our patient population.
CLINICAL IMPLICATIONS: Enoxaparin bridging is a safe and effective means of bridging patients. Our analysis shows no increase risk of bleeding or thromboembolic complications with 1.5mg/kg per day or 1mg/kg twice a day. Once a day dosing offers a much more convenient alternative to twice a day dosing from both a patient and practitioner standpoint.
DISCLOSURE: Aaron Ford, No Financial Disclosure Information; No Product/Research Disclosure Information