Effects of different anticoagulant drugs on the prevention of complications in patients after arthroplasty

Gao, Jihai; Chu, Xiu-Cheng; Wang, Lin-Liang; Niu, Bo; Zhao, Chuan-Xin

doi:10.1097/md.0000000000008059

Cited by 5 publications

(4 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Apixaban is a direct inhibitor of factor Xa (free as well as clot-bound); it selectively and reversibly inhibits the conversion of prothrombin into thrombin, which is the final step for the formation of a clot; it was also reported to be associated with fewer chances of bleeding postoperatively in a meta-analysis that is also in accordance with the present findings [20,21]. We prescribed Rivaroxaban 10 mg as a once-daily oral regime for four weeks for DVT prophylaxis to our patients postoperatively, which proved more convenient to the patient in comparison with apixaban, which is a twice-daily dose.…”

Section: Discussionsupporting

confidence: 90%

Primary Total Knee Replacement: A Recipe for Dry Dressing

Khanzada¹,

Awadelkarim²,

Rahman³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 90%

Primary Total Knee Replacement: A Recipe for Dry Dressing

Khanzada¹,

Awadelkarim²,

Rahman³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…Three major studies of safety comparisons were identified in the literature: LMWH versus ASA 248 , non-vitamin-K oral anticoagulants (NOAC, including direct factor Xa inhibitors and other, such as rivaroxaban, dabigatran, apixaban, ximelagatran, etc.) versus LMWH 249-262 or ASA 263-265 , and NOAC of different groups comparing to each other 252,266 . Bleeding rates are not always reported, and bleeding risks may be used as the surrogate.…”

Section: - Which Vte Prophylactic Agent Used In Patients Undergoing T...mentioning

confidence: 99%

“…NOAC comparisons report slightly different bleeding rates for each agent against LMWH (usually enoxaparin) and among them. A synthesis includes: major bleeding in 1.4% (220 mg) or 1.1% (150 mg) vs. 1.4% (3 trials and 8,135 patients in dabigatran vs enoxaparin 251 ,); major or non-major, clinically relevant bleeding RR vs. enoxaparin of 1.52 (ribaroxaban), 0.34 (betrixaban), 0.88 (apixaban), 0.85 (darexaban), 1.30 (edoxaban) 250 ; better preventive effects on bleeding with apixaban 252 ; RR of major bleeding of oral direct factor Xa inhibitors vs. enoxaparin, 1.27 (5 trials, 12,184 patients with THA) and 0.94 (5 trials, 13,169 patients with TKA) being non significantly different from enoxaparin 253 ; less bleeding (and less efficacy) of enoxaparin vs. immediately postop ximegalatran with hip odds ratio (OR) = 0.30 and knee OR = 0.71 (6 trials, 10,051 THA or TKA patients) 254 ; compared to enoxaparin, the RR of clinically significant risk of bleeding was higher with rivaroxaban (RR = 1.25), similar with dabigatran (RR = 1.12) and lower with apixaban (RR = 0.82) in a meta-analysis of 16 trials, 38,747 THA or TKA patients 256 ; compared with dabigatran, enoxaparin similarly efficacious and similar risk of bleeding (OR = 0.90), while compared with rivaroxaban, enoxaparin less efficacious but lower risk of bleeding (OR = 0.79) in a meta-analysis with 6 trials, 18,405 THA or TKA patients 257 ; in a network meta-analysis with 19 trials and 43,838 THA or TKA patients, OR were also calculated against enoxaparin 30 mg twice a day ( bis in die [bid]) or 40 mg daily, and bleeding (major/non-major clinically relevant) was significantly increased for fondaparinux (vs. 40 mg daily, OR = 0.67) and rivaroxaban (vs. 40 mg daily, OR = 0.77) 258 , while apixaban as the comparator (2.5 mg bid) showed increased bleeding with enoxaparin 30 mg bid (OR = 0.75), dabigatran (OR = 0.73), fondaparinux (OR = 0.56), and rivaroxaban (OR = 0.65); a meta-analysis with 21 randomized control trials (RCT) 259 produced major bleeding rates with enoxaparin of 1.32%, dabigatran 1.25%, rivaroxaban 2.02%, apixaban 0.70%, ximegalatran 0.93%; a pooled analysis of 2 RCT with 8,464 THA or TKA patients comparing apixaban and enoxaparin showed a major bleeding rate of 0.7% and 0.8%, but when non-major clinically relevant bleeding was summed, the rates were 4.4% for apixaban and 4.9% for enoxaparin 260 . As a summary, major bleeding rates for enoxaparin were reported from 0.8 to 1.3%, for dabigatran 1.1 to 1.4%, for apixaban around 0.7, for rivaroxaban around 2%.…”

Section: - Which Vte Prophylactic Agent Used In Patients Undergoing T...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Hip & Knee

2022

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

The ICM-VTE Hip & Knee Delegates* 1 -Is VTE after elective total joint arthroplasty a "never event"?Response/Recommendation: Venous thromboembolism (VTE) after elective total joint arthroplasty (TJA) continues to occur despite various strategies in prophylaxis and should not be considered a "never event."Strength of Recommendation: Moderate.Delegates vote: Agree 94.87% Disagree 5.13% Abstain 0.00% (Strong Consensus).Rationale: As part of an initiative to address quality of care and control healthcare costs, in 2002, the United States Centers for Medicare and Medicaid Services (CMS) defined "never events" as hospital-acquired conditions that were considered reasonably preventable 1 . In 2008, CMS added deep venous thrombosis (DVT) and pulmonary embolism (PE) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) 2 .Historically, DVT and PE were important risks for patients undergoing TJA. In a study of 7,959 patients between 1962 and 1973, Charnley et al., reported a non-fatal PE rate of 7.89% and a 1.04% rate of fatal PE which constituted the highest single cause of death after a THA 3 . Coventry et al., identified a cohort of 2012 THA from 1969 to 1971 of which 58 did not receive chemoprophylaxis past post-operative day five and observed a DVT rate of 3.4%, a non-fatal PE rate of 5.2%, and a fatal PE rate of 3.4% 4,5 . In a series performed between 1990 and 1991, Warwick et al., identified 1,162 patients undergoing THA without routine chemoprophylaxis, with DVT confirmed by venography in 1.89% of patients and a PE rate of 1.20% with a subsequent mortality rate of 0.34% 6 .Early studies demonstrated a much higher incidence of VTE for TKA 7,8 . However, DVT in TKA patients occur distally in the calf which are less likely to progress into a PE which was observed at a rate of 1.3% 9 with fatalities of 0.19 to 0.4% 9,10 . Stulburg et al., examined a series of 638 patients from 1974 to 1979 among which 49 patients inadvertently did not receive prophylaxis; an impressive 83% of these patients developed a DVT 11 .In a prospective study with 34,397 consecutive and unselected THA or TKA procedures, 32 (0.09%) had a VTE after median two days despite ongoing thromboprophylaxis 12 . All surgery was done in a fast-track setup with accelerated mobilization and discharge. Another study has shown a 90-day incidence of 0.41% of VTE after unicompartmental knee arthroplasty 13 . All patients received thromboprophylaxis until discharge and were operated in a fast-track setup with a median length of stay of one day.With VTE as a common and potentially dangerous complication after TKA and THA, safe and effective strategies for prophylaxis were developed and studied. When warfarin dosage is titrated to an international normalized ratio (INR) of 1.5 to 2.0 and administered for approximately six weeks, DVT occurred at a rate of 0.2 to 1% with a non-fatal PE rate of 0.1 to 0.3% [14][15][16] . Warfarin was found to consistently decreased rates of VTE when utilized after THA or TKA, but may lead to a significant risk ...

show abstract

“…Venous thromboembolism (VTE) (including deep vein thrombosis [DVT] and pulmonary embolism [PE]) remains one of the major causes of morbidity, mortality, and costs in total hip and knee arthroplasty (THA/TKA) 1 . Compliance with clinical practice guidelines (CPG) has been inconsistent due to concerns with the quality and recency of evidence, the relevance of symptomatic versus asymptomatic VTE, and the need to balance the risks and benefits of VTE prophylaxis against the risk of bleeding and surgical site infection 2 – 4 .…”

Section: Introductionmentioning

confidence: 99%

Compliance with Australian Orthopaedic Association guidelines does not reduce the risk of venous thromboembolism after total hip and knee arthroplasty

Badge,

Churches,

Naylor

et al. 2024

Sci Rep

View full text Add to dashboard Cite

Preventing avoidable venous-thrombo-embolism (VTE) is a priority to improve patient and service outcomes after total hip and total knee arthroplasty (THA, TKA), but compliance with relevant clinical guidelines varies. This study aims to determine the degree to which prophylaxis was compliant with Australian Orthopaedic Association (AOA) VTE prophylaxis guidelines and whether non-compliance is associated with increased risk of VTE. A prospective multi-centre cohort study of adults with osteoarthritis undergoing primary TKA/THA was completed at 19 high-volume public and private hospitals. Data were collected prior to surgery and for one-year post-surgery. Logistic regression was undertaken to explore associations between non-compliance with AOA VTE prophylaxis guidelines and symptomatic 90-day VTE outcomes. Data were analysed for 1838 participants from 19 sites. The rate of non-compliance with all clinical guideline recommendations was 20.1% (N = 369), with 14.1% (N = 259) non-compliance for risk-stratified prophylaxis, 35.8% (N = 658) for duration, and 67.8% (N = 1246) for other general recommendations. Symptomatic VTE was experienced up to 90-days post-surgery by 48 people (2.6%). Overall guideline non-compliance (AOR = 0.93, 95%CI = 0.4 to 1.3, p = 0.86) was not associated with a lower risk of symptomatic 90-day VTE. Results were consistent when people with high bleeding risk were excluded (AOR = 0.94, 95%CI = 0.44 to 2.34, p = 0.89). Non-compliance with the AOA VTE prophylaxis guidelines was not associated with risk of 90-day VTE after arthroplasty. This counterintuitive finding is concerning and necessitates a rigorous review of the AOA VTE prevention clinical guideline.

show abstract

Effects of different anticoagulant drugs on the prevention of complications in patients after arthroplasty

Abstract: Supplemental Digital Content is available in the text

Cited by 5 publications

References 41 publications

Primary Total Knee Replacement: A Recipe for Dry Dressing

Primary Total Knee Replacement: A Recipe for Dry Dressing

Recommendations from the ICM-VTE: Hip & Knee

Compliance with Australian Orthopaedic Association guidelines does not reduce the risk of venous thromboembolism after total hip and knee arthroplasty

Contact Info

Product

Resources

About