Coumadin vs. Lovenox after joint replacement

[natkat2816]

Just wanting to know what everyones opinion was between coumadin vs. lovenox for ortho patients after total joint replacement?? What are your docs using?? Do they have a preference?? Why? Any side effects noted??

[julesAR]

Hi,

I work on a 40 bed med/surg unit and Lovenox is the drug of choice

for joint replacement sx. The only time I see Coumadin used is if a

patient is already on it for DVT hx.

[november17, ASN, RN]

We have 1 surgeon that uses aspirin, one that uses warfarin, and another that uses lovenox. I think I see lovenox more than anything else though

[suehp]

One of our Docs has changed from Coumadin to Aspirin, but most of our Docs use Coumadin or heparin...rarely see Lovenox

[jnette, ASN, EMT-I]

All our HH patients are sent home on Lovenox after sx. :)

[MNmom3boys]

Ours are all on a Coumadin protocol - very few Lovenox. (Usually only if were previously perscribed, and managed by medical doc, not orthopod.)

[natkat2816]

Thanks for all your answers. I was just curious cause I'm gonna be on a committee about that. We use mostly coumadin but have a few docs that use lovenox. I guess that may change in the future too as the hospital is going to switch from lovenox to arixtra (which I know nothing about yet).

[dria]

i work with a national caseload, so i have a bit of a different perspective. here's my two cents:

most thas are sent home on asa

most tkas are sent home on either lovenox or coumadin (about 50/50)

the above is true...except for the state of fl. seems like all the joints there are sent home on coumadin (broad generalization...i know....but i notice more thas from fl on coumadin than any other state....just an interesting observation)

working from a case management perspective, the concern i would have (and please understand my inpatient experience is....a bit..."rusty"...) is that a standard anticoagulation protocol does not take into account for variations in benefits. i am going to hold on elaborating on this because the details will likely bore you to tears....but i know the joints we see are getting younger and younger, so its no longer true that you only have to worry about medicare.

likely not quite what you are looking for....but i'm wondering if your discharge planners are involved in this comittee?

[RN and Mommy]

a lot of our docs actually use both coumadin and lovenox. we start coumadin the night of surgery and then the next day lovenox is initated. we discontinue the lovenox when the inr is 2.0. the patient will then go home only on coumadin unless there is some other reason.

[jmgrn65, RN]

I think the trend is to use coumadin, it is becoming the gold standard.

[emmakirst]

Our ortho doc use either the warfarin protocol or fragmin. They never use lovenox or heparin

[P_RN, ADN, RN]

What I noticed is that Lovenox cost would cause some to discontinue early. Warfarin would run about $1 a day I believe. Lovenox about 10. This would be if there is no drug coverage such as insurance and Medicare-D.