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Internal Medicine

Answer 4
  1. Enoxaparin 40 mg daily. Deep venous thrombosis (DVT) is a potentially fatal complication of hip fracture surgery and results from immobility, endothelial damage from the injury and surgical trauma, and a postsurgical hypercoagulable state. In fact, hip surgery is one of the most likely operations to result in postoperative DVT. As such, prevention of postoperative DVT is of interest not only to orthopaedic surgeons but also to medical physicians who frequently comanage these patients. Many prophylactic regimens have been studied and include aspirin, subcutaneous heparin, warfarin, and low-molecular-weight (LMW) heparins (ie, enoxaparin). While warfarin has been used effectively for many years, drugs such as enoxaparin have emerged as the prophylaxis of choice for patients with hip fracture.5 Enoxaparin dosages of 40 mg daily or 30 mg twice daily frequently are utilized, but 5 mg is not an adequate dose. Leg elevation and subcutaneous heparin are not effective. Aspirin is inferior to LMW heparins but may offer some protection in patients with contraindications to these agents.

     Kaboli P, Henderson MC, White RH. DVT prophylaxis and anticoagulation in the surgical patient. Med Clin North Am 2003;87:77–110.

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