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From the July ACP Hospitalist, copyright © 2007 by the American College of Physicians.
Reader praise
ACP Hospitalist is superior. I get more useful information per minute of reading time than from any of my many other sources. I teach students, medical residents and fellows daily and find your articles to be highly useful as a means of reviewing recent studies and recommendations.
Clifford W. Zwillich, MACP
Denver
Questions about LMWH
Photo by BSIP/Photo Researchers Inc.
In the "Test yourself" section of the May 2007 issue, the description of high-dose low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) prophylaxis after knee surgery is confusing. It could suggest to clinicians that a "therapeutic" rather than prophylactic dose be used. Most clinicians refer to either "therapeutic" or "prophylactic" doses of LMWH. Most practicing clinicians would be familiar with the fact that there are different prophylactic doses of enoxaparin (30 mg every 12 hours, 30 mg/d and 40 mg/d), but calling 30 mg every 12 hours "high dose" could lead to use a "therapeutic" dose of 1 mg/kg of body weight every 12 hours or 1.5 mg/kg per day.
Also, while dalteparin and tinzaparin are not FDA-approved for VTE prophylaxis following orthopedic surgery, most clinicians would agree that they are interchangeable with enoxaparin (unless the legal department runs the pharmacy and therapeutics committee in your institution).
Emilio V. Perez-Jorge, ACP Member
Dayton, Ohio
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