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The effects of preoperative prophylactic administration of enoxaparin on intraoperative and postoperative bleeding in hip fracture surgeries
Mohammad Golparvar, Fatemeh Moghadassi ,
Volume 82, Issue 7 (10-2024)
Abstract
Background: Intraoperative bleeding is an unwanted and common complication in orthopedic surgeries, which can be aggravated by the preventive administration of anticoagulants to prevent deep vein thrombosis. The present study examines the effect of prophylactic enoxaparin to prevent thromboembolism on the amount of bleeding in femoral head surgeries where it is not possible to use a tourniquet.
Methods: A prospective descriptive-analytical study was conducted from July to March 2017 in Kashani Hospital, Isfahan, in 120 patients without a history of coagulation disorders who were candidates for reconstructive surgery for femoral head and neck fractures. Inclusion criteria involved age over 18, BMI less than 30, no history of coagulation disorders, no preoperative use of anticoagulant drugs, normal PT, PTT, and INR before starting enoxaparin. The patients didn’t have any coagulation disorder and all of them were under prophylactic dose of enoxaparin before surgery. The patients were subjected to spinal anesthesia with the same method. Signs related to degree of bleeding recorded during surgery and recovery care.  Data were collected and entered into SPSS software version 20, and central tendency and dispersion indices were calculated for quantitative variables. Descriptive tables and charts were utilized for qualitative variables. Correlation coefficient and linear regression analyses were performed for the final interpretation of results.
Results: There was a significant relationship between mean arterial pressure and intraoperative bleeding (p-value=0.001). The dose of enoxaparin prescribed was associated with the volume of fluids received, the amount of bleeding, the amount of tranexamic acid, phenylephrine, labetalol, TNG and fentanyl administered during the operation with a p-value of less than 0.05. Also, there is a significant relationship between the prescribed dose of enoxaparin and the duration of surgery and duration of recovery care (p-value less than 0.05).
Conclusion: The study examines the impact of prophylactic enoxaparin on intraoperative bleeding, finding a significant correlation with dosage and duration. No notable difference in bleeding was observed in patients with a GFR below 30. Enoxaparin administration correlated with increased bleeding, MAP levels, fluid volume, tranexamic acid use, and hypotension medications during surgery.

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