Enoxaparin versus No Anticoagulation Prophylaxis
after Total Knee Arthroplasty in Thai Patients:
A Randomized Controlled Trial
Tawan Intiyanaravut MD*, Nimit Thongpulsawasdi MD*, Napol Sinthuvanich MD*,
Sirirat Teavirat MD**, Mutita Kunopart MD***
Affiliation :
* Department of Orthopaedic Surgery, Golden Jubilee Medical Center, Mahidol University, Nakhon Pathom,
Thailand
** Department of Radiology, Golden Jubilee Medical Center, Mahidol University, Nakhon Pathom, Thailand
*** Department of Anesthesiology, Golden Jubilee Medical Center, Mahidol University, Nakhon Pathom, Thailand
Background : There has been some controversy about routine use of thromboprophylaxis after total knee arthroplasty (TKA)
in Asian patients.
Objective : To compare the efficacy and safety of enoxaparin in preventing venous thromboembolic diseases after TKA in
Asian patients.
Material and Method: We randomized 50 patients undergoing primary TKA into two equal groups, 25 patients received once
daily subcutaneous enoxaparin injections as thromboprophylaxis and 25 control patients did not receive anticoagulation. The
primary outcome was deep vein thrombosis (DVT) identified by color Doppler ultrasonography and/or pulmonary embolism
(PE). All significant bleeding complications were recorded.
Results : Deep vein thrombosis occurred in only one patient in the control group (4%) and in none in the enoxaparin group
(0%, p = 0.31). No patient in both groups had clinical signs of PE. No patient had significant bleeding complications. One
patient in enoxaparin group had a minor bleeding complication (4%) and also a surgical wound complication.
Conclusion : We concluded that the incidence of thromboembolic diseases after primary TKA in Thai patients is very low.
Enoxaparin had no significant benefit in reducing venous thromboembolic complications after TKA in Asian patients,
however it is safe in term of bleeding complications. We do not recommend routine use of enoxaparin as thromboprophylaxis
after TKA in Asian patients.
Keywords : Asians, deep vein thrombosis, enoxaparin, knee arthroplasty, low-molecular-weight-heparin, thromboprophylaxis
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