QuestionPrescription
QuestionComment
why not fondaparinux?
61062
QuestionComment
it is an antithrombin, this patient needs LMWH or aspirin 
61793
User
subscriber
DoccyDatters
User
subscriber
Ortho bro
QuestionComment
What's wrong with enoxaparin sodium 150 mg/mL injection with 40mg SC daily? 
61524
QuestionComment
Probably because in reality if you are trying to get 40mg from 100mg/ml you can give 0.4ml but if it's 150 its like 0.375 I think?
61594
User
subscriber
Epidermis Benign
User
subscriber
Claire
QuestionComment
i put stat as first dose is stat as bnf says: 40 mg for 1 dose, dose to be given 12 hours before surgery, then 40 mg every 24 hours. but got it wrong
61894
User
subscriber
SuturedAndBooted
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3633
Prescribing VTE prophylaxis
Topic
13
Neurosurgery
## Drug choice feedback

This patient requires a low molecular weight heparin as prophylactic treatment of venous thromboembolism prior to his surgery. The options available are tinzaparin, enoxaparin, bemiparin and dalteparin. They are often given at 6pm, this provides cover until the day of the surgery. DOACs such as rivaroxaban are now also licensed to be given as VTE prophylaxis **AFTER** (and so are incorrect answers for this question) specific procedures (such as knee and hip replacements) and these should be taken daily for 2 weeks. Similarly, Fondaparinux is not acceptable as per the BNF, which only provides information on prescribing it for VTE prophylaxis **post-surgery.**

# Dose/Route/Frequency/Duration feedback

The following prescriptions are appropriate to provide prophylaxis against venous thromboembolism:

- Enoxaparin 40mg subcutaneous OD
- Tinzaparin 4500 units subcutaneous OD
- Dalteparin 5000 units subcutaneous OD
- Bemiparin 3500 units subcutaneous OD

10104
PrescriptionAnswer
PrescribeAnswerData
3500 units
PrescribeAnswerData
bemiparin sodium 10 000 units/mL injection
PrescribeAnswerData
Reviewed at discharge
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
subcutaneous (SC)
PrescriptionAnswer
PrescribeAnswerData
75 mg
PrescribeAnswerData
aspirin 75 mg tablets
PrescribeAnswerData
Reviewed at discharge
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
40 mg
PrescribeAnswerData
enoxaparin sodium 100 mg/mL injection
PrescribeAnswerData
Reviewed at discharge
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
subcutaneous (SC)
PrescriptionAnswer
PrescribeAnswerData
5000 units
PrescribeAnswerData
dalteparin sodium 10 000 units/mL injection
PrescribeAnswerData
Reviewed at discharge
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
subcutaneous (SC)
PrescriptionAnswer
PrescribeAnswerData
4500 units
PrescribeAnswerData
tinzaparin sodium 10 000 units/mL injection
PrescribeAnswerData
Reviewed at discharge
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
subcutaneous (SC)
Case Presentation: A 63-year-old gentleman is brought onto the orthopaedic ward for an elective total knee replacement of his right knee. 


## PH
Osteoarthritis

## DH
Ibuprofen 400mg PO QDS, lansoprazole 30mg PO OD. NKDA.

## On examination

Temperature 37.1°C, HR 68, RR 13, BP 131/75, O<sub>2</sub> 98% RA, GCS 15, Weight 90kg

## Investigations

Nil

## Prescribing Request

Write a prescription for one drug that is most appropriate to provide cover against venous thromboembolism. It is the day before his elective surgery.