Weight-adjusted low molecular weight heparin with surgery morning dose administration: Impact on hip hemiarthroplasty...

Several studies have questioned the efficacy of the standard perioperative low-molecular-weight heparin (LMWH) dose in preventing venous thromboembolic complications and have recommended dose escalation to a weight-based regimen. Other studies, however, have cautioned that higher anticoagulation regimens may be associated with an elevated risk of wound complications and periprosthetic joint infections. This dichotomy underscores the need for identifying the safety of the thromboprophylaxis approach in surgical settings.

To analyze the effect of LMWH regimen modification to weight-based with dose administration the morning of surgery on the incidence of early (within 3 months) postoperative prosthetic joint infection (PJI) in patients with hip hemiarthroplasty (HA).

At our multi-hospital health system, LMWH dose escalation to the weight-based regimen without holding the morning dose on the day of surgery started in mid-June 2019. We have reviewed all cases of HA performed at our institution from 2007 to 2024 and divided them into two groups: Before and after the dose modification protocol. The number of early PJI cases has been studied in each group.

A total of 33 HA early PJI cases fit the study selection criteria and were included in this study. Of the 1517 cases performed before the new protocol, 19 cases (1.25%) had early infections, while within the modified protocol (weight-based with morning dose), 14 cases (1.49%) had infections out of a total of 937 cases. The difference between the two groups was found to be not statistically significant (z = -0.5, P = 0.6).

Our results indicate that LMWH dose escalation to a weight-based regimen without withholding the LMWH morning dose on the day of surgery did not lead to a significant change in the rate of early PJI in this study. A larger, multicenter study would be ideal for providing stronger evidence.