Update in Perioperative Medicine
Authors: Stephen A. Hilty
Journal: Annals of Internal Medicine (2004)

Letters21 September 2004Update in Perioperative MedicineStephen A. Hilty, MDStephen A. Hilty, MDFrom San Luis Obispo, CA 93405.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-141-6-200409210-00029 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Smetana and colleagues (1) stated that extended-duration thromboprophylaxis should be used for patients undergoing high-risk orthopedic surgery and abdominal cancer surgery. Because of cost, our local transitional care facility will not accept a patient receiving low-molecular-weight heparin (usually enoxaparin). Given some evidence that low-molecular-weight heparin is superior to warfarin (2-5), how would the authors handle this situation? I'm not aware of any study comparing extended-duration warfarin with extended-duration low-molecular-weight heparin. I'm also not aware of any study that examines initial therapy with low-molecular-weight heparin followed by extended-duration warfarin therapy outside of the hospital setting.Stephen A. Hilty, ...References1. Smetana GW, Cohn SL, Lawrence VA. Update in perioperative medicine. Ann Intern Med. 2004;140:452-61. [PMID: 15023711] LinkGoogle Scholar2. Leclerc JR, Geerts WH, Desjardins L, Laflamme GH, L'Esperance B, Demers C, et al . Prevention of venous thromboembolism after knee arthroplasty. A randomized, double-blind trial comparing enoxaparin with warfarin. Ann Intern Med. 1996;124:619-26. [PMID: 8607589] LinkGoogle Scholar3. Colwell CW, Collis DK, Paulson R, McCutchen JW, Bigler GT, Lutz S, et al . Comparison of enoxaparin and warfarin for the prevention of venous thromboembolic disease after total hip arthroplasty. Evaluation during hospitalization and three months after discharge. J Bone Joint Surg Am. 1999;81:932-40. [PMID: 10428124] CrossrefMedlineGoogle Scholar4. Hull R, Raskob G, Pineo G, Rosenbloom D, Evans W, Mallory T, et al . A comparison of subcutaneous low-molecular-weight heparin with warfarin sodium for prophylaxis against deep-vein thrombosis after hip or knee implantation. N Engl J Med. 1993;329:1370-6. [PMID: 8413432] CrossrefMedlineGoogle Scholar5. Francis CW, Pellegrini VD, Totterman S, Boyd AD, Marder VJ, Liebert KM, et al . Prevention of deep-vein thrombosis after total hip arthroplasty. Comparison of warfarin and dalteparin. J Bone Joint Surg Am. 1997;79:1365-72. [PMID: 9314399] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From San Luis Obispo, CA 93405. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPrevention of Venous Thromboembolism after Knee Arthroplasty Jacques R. Leclerc , William H. Geerts , Louis Desjardins , George H. Laflamme , Bernard l'Esperance , Christine Demers , Jeannine Kassis , Moira Cruickshank , Lucinda Whitman , and Fernand Delorme Update in Perioperative Medicine Gerald W. Smetana , Steven L. Cohn , and Valerie A. Lawrence Update in Perioperative Medicine Gerald W. Smetana , Steven L. Cohn , and Valerie A. Lawrence Update in Perioperative Medicine Paul Casner Metrics 21 September 2004Volume 141, Issue 6Page: 486KeywordsAbdominal surgeryLow molecular weight heparinOrthopedic surgery ePublished: 21 September 2004 Issue Published: 21 September 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...