PULMONARY EMBOLISM CASES WHICH OCCURRED UNDER ENOXAPARIN SODIUM 4000 IU PROPHYLAXIS

Abstract

TOPIC: Pulmonary Vascular Disease TYPE: Global Case Reports INTRODUCTION: Some surgical based guidelines recommends standart 4000 IU Enoxaparin for VTE prophylaxis. However fixed dose enoxaparin will often fail to achieve therapeutic levels, since for therapeutic anticoagulation, enoxaparin is dosed based on weight (1mg/kg). To draw attention to this issue, we presented 3 cases who developed PE while receiving 4000 IU Enoxaparin prophylaxis. CASE PRESENTATION: Cases Case 1:A 27-year-old, 72 kilogram male patient, who had no known chronic disease history, was using Enoxaparin sodium 4000 international units (IU) regularly once a day after the meniscus operation. Complaints of back pain and shortness of breath developed two weeks after the operation In the computed tomography pulmonary angiography(CTPA), filling defects in the middle and lower lobar branches of the right lung and extending to the lingular segment of the upper lobe of the left lung were seen. The patient was followed up in our department with the diagnosis of bilateral lobar pulmonary embolism (PE).Case 2:An 80-year-old 65-kilogram female patient with a known chronic obstructive pulmonary disease, atrial fibrillation (AF), hypertension, was using a new generation oral anticoagulant (NOAC) due to AF. NOAC was discontinued upon the development of ecchymotic lesions in the body, and Enoxaparin sodium 4000 IU was added to the treatment once a day.. Three weeks after the treatment change, the patient was admitted to the emergency department with the complaint of dyspnea, and a thrombus extending from the distal of both main pulmonary arteries to the bilateral lower and upper lobe bronchial artery was detected in the CTPA, and he was followed up in our service with the diagnosis of massive PE. DISCUSSION: Case 3: An 81 years old, 67-kilogram female patient with a diagnosis of hypertension and Alzheimer's disease admitted to the hospital with complaints of shortness of breath and swelling in the legs for a week. Seven months ago, Enoxaparin sodium 4000 IU was planned twice a day in an external center due to pulmonary embolism. The patient continued to use LMWH 4000 IU once a day after the 3rd month of his own request. CTPA revealed filling defects in the right pulmonary artery upper lobe posterior and lower lobe posterobasal segments. Lower extremity venous Doppler ultrasonography revealed deep vein thrombus (DVT). When compared with previous examinations, it was observed that pulmonary embolism had newly developed and the patient was followed up with segmental PE + DVT diagnoses. CONCLUSIONS: Although low-dose LMWH treatment is recommended in some guidelines and drug package insert for PE prophylaxis, the cases we have presented suggest that it would be safer to consider the patient's weight when administering LMWH prophylaxis. REFERENCE #1: Prophylactic Enoxaparin Dosing in Obese Orthopedic Patients: A Literature SearchVan N Tran 1, Ilya Varfolomeev 2, Geoff Hill 3 DISCLOSURES: No relevant relationships by MELTEM GUNDUZ, source=Web Response No relevant relationships by H.Canan Hasanoglu, source=Web Response