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Should we be following anti-factor Xa levels in patients receiving prophylactic enoxaparin perioperatively?

Published:October 03, 2016DOI:https://doi.org/10.1016/j.surg.2016.07.038
      Post-operative patients are known to be at increased risk for perioperative venous thromboembolism (VTE), a potentially life- or limb-threatening complication that affects patients across the spectrum of operations. Randomized, control trials as well as cohort studies have demonstrated clearly that the risk of VTE can be decreased with perioperative chemoprophylaxis, but these studies also demonstrate that risk reduction is not complete—the expected risk reduction is 50% in both randomized and nonrandomized studies. This means that 2–10% of the patients at greatest risk have a VTE event despite receipt of chemoprophylaxis; these “breakthrough” VTE events have substantial ramifications at the level of patients, hospital systems, and government entities that make and endorse guidelines.
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