Comparison of Efficacy of Low Molecular Weight Heparin Versus Oral Anticoagulant in Indian Population for Prevention of Deep Vein Thrombosis in Total Knee Replacement

Abstract

Nearly 50% of patients who undergo TKR develop symptomatic/ asymptomatic DVT without prophylaxis. Since LMWH is costly, subcutaneous injection and inconvenience to patient, Oral anticoagulant is used as alternative. It is a prospective study where patients were observed for 15 days, following TKR. The effectiveness of LMWH Vs Oral anticoagulant in Indian population was done comparing 100 patients who underwent TKR. Inclusion criteria -age more than 18 years, under any anesthesia, Indian origin. Exclusion criteria were head injury, abdominal injury,poly trauma, history of DVT, indwelling epidural catheter. Oral anticoagulant used in the study Dabigatran etexilate 220 mg OD or Apixaban 2.5 mg BD for 15 days. Patient was done colour doppler pre-operatively, POD-(3-5) and (13-15). In 100 patients, 25 patients were given Dabigatran, 25 were given Apixaban and 50 were given LWMH. The absolute risk difference -1.1% in favour of oral anticoagulant. Thus oral anticoagulants was non-inferior to LMWH (P<0.0001). Major bleeding occurred in 2 patients in oral anticoagulant group but none were fatal or required discontinuation of drug. The study showed both oral anticoagulants given for 15 days were as effective as LMWH for prevention of DVT in TKR. Oral anticoagulant proved to be non-inferior to LMWH. Oral anti-coagulant is effective, well tolerated, low rate of bleeding, no evidence of elevated liver enzymes or acute coronary events when compared to LMWH.