Efficacy and Safety of Thromboprophylaxis Post-Orthopedic Surgery

Alsheikh, Khalid; Hilabi, Ahmed; Aleid, Abdulaziz; Alharbi, Khalid G.; Alangari, Hussam S.; Alkhamis, Mohammed M.; Alzahrani, Faisal; AlMadani, Wedad

doi:10.7759/cureus.19691

Cited by 7 publications

(9 citation statements)

References 34 publications

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“…They are the most commonly used and effective anticoagulants for the prevention and treatment of various thromboembolic diseases. This study found that there was no statistically signi cant difference in the treatment effect and DVT incidence among patients in LMWH group, FPX group, and Rivaroxaban group, indicating that three groups of anticoagulants can all reduce the incidence of VTE after THA, which was consistent with the research conclusion of Alsheikh K, et al [17]. However, in terms of treatment cost ratio, the FPX group was signi cantly higher than the other two groups, indicating that LMWH and Rivaroxaban were more economical than FPX; For the portability of drug use for patients, Rivaroxaban can be taken orally directly compared with LMWH and FPX, which is more convenient and faster, and reduce the complications of injection pain, infection, poor compliance caused by subcutaneous injection [18].…”

Section: Discussionsupporting

confidence: 87%

“…However, due to the lack of consistency in the de nition of "bleeding", makes it di cult to explain the true balance of advantages and disadvantages. A large number of studies have shown that [19][20], LMWH, FPX, and Rivaroxaban have no signi cant differences in VTE-related mortality, massive hemorrhage, and adverse events. The three drugs have good safety and effectiveness in the prevention and treatment of VTE.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the Therapeutic Effect of Different Anticoagulation Regimens after Total Hip Arthroplasty based on ERAS

Cao

Saad

Pan

et al. 2022

Preprint

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Objective To compare the efficacy of low molecular weight heparin (LMWH), fondaparinux sodium (FPX), and rivaroxaban after total hip arthroplasty (THA) under Enhanced Recovery After Surgery (ERAS). Method The clinical data of patients who underwent primary THA due to hip joint disease in Ningxia Medical University General Hospital from October 2020 to June 2022 were retrospectively collected and analyzed. According to different anticoagulant methods, patients were divided into LMWH group (42 cases), FPX group (24 cases), and Rivaroxaban group (39 cases). Detect and record changes of blood coagulation-related factors, D-dimer, platelet (PLT) changes, blood routine, blood loss, lower limb vein thrombosis (DVT), pulmonary embolism, and allogeneic blood transfusion in the three groups perioperatively. Result There was no statistical significance in the comparison of coagulation indexes before the operation among the three groups (P > 0.05), but there was statistical significance in the comparison of PT and INR levels at 3 days after the operation (P < 0.05). There was a statistically significant difference between the Hb before operation and the Hct 3 days after operation in the three groups (P < 0.05). The postoperative drainage volume and overt blood loss of the three groups were statistically significant (P < 0.05), but there were no significant differences in intraoperative blood loss, hidden blood loss, and total blood loss (P > 0.05). There was no significant difference in VAS score, blood transfusion rate, and DVT incidence rate among the three groups before and 3 days after surgery (P > 0.05), and the treatment cost ratio of patients in LMWH group was lower than that of FPX group and Rivaroxaban group, the difference was statistically significant (P < 0.05). Conclusion Based on the ERAS concept, the use of LMWH, FPX, and Rivaroxaban after THA can effectively and safely prevent the occurrence of VTE and has no significant difference in postoperative pain, perioperative blood loss, and coagulation function. However, Rivaroxaban can be taken orally directly and has more advantages in pharmacological effects, while LMWH is cheaper and more economical.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Comparison of the Therapeutic Effect of Different Anticoagulation Regimens after Total Hip Arthroplasty based on ERAS

Cao

Saad

Pan

et al. 2022

Preprint

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“…The use of aspirin remains controversial although it is now recommended in several VTE clinical guidelines when used as part of a comprehensive VTE prophylaxis program. VTE, SSI and bleeding outcomes for aspirin prophylaxis have been shown to be no different to potent anticoagulants 18 – 20 . However other studies have reported aspirin is associated with an increased incidence of DVT and wound complications, but a lower risk of bleeding 21 – 23 .…”

Section: Discussionmentioning

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

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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.

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“…These include agents that prevent platelet activation, aggregation, and/or adhesion, known as antiplatelets, and others that inhibit clotting factors, known as anticoagulants. When choosing a pharmacological thromboprophylaxis agent for patients undergoing major lower-extremity orthopedic procedures, who possess a low risk of bleeding, factors such as the specific type of surgery and comorbidities play a role in the decision-making process [ 23 , 24 , 25 , 26 , 27 ].…”

Section: Current Methodsmentioning

confidence: 99%

“…In cases when UFH injections are undesirable, warfarin may be considered as an alternative option. Nevertheless, it is important to note that patients with heparin-induced thrombocytopenia (HIT) or a history of HIT should be treated with a non-heparin agent [ 3 , 4 , 5 , 6 , 7 , 23 , 24 , 25 , 26 , 27 ].…”

Section: Current Methodsmentioning

confidence: 99%

Venous Thromboembolism Prophylaxis in Major Orthopedic Surgeries and Factor XIa Inhibitors

Jones

Al‐Horani

2023

Medical Sciences

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Venous thromboembolism (VTE), comprising pulmonary embolism (PE) and deep vein thrombosis (DVT), poses a significant risk during and after hospitalization, particularly for surgical patients. Among various patient groups, those undergoing major orthopedic surgeries are considered to have a higher susceptibility to PE and DVT. Major lower-extremity orthopedic procedures carry a higher risk of symptomatic VTE compared to most other surgeries, with an estimated incidence of ~4%. The greatest risk period occurs within the first 7–14 days following surgery. Major bleeding is also more prevalent in these surgeries compared to others, with rates estimated between 2% and 4%. For patients undergoing major lower-extremity orthopedic surgery who have a low bleeding risk, it is recommended to use pharmacological thromboprophylaxis with or without mechanical devices. The choice of the initial agent depends on the specific surgery and patient comorbidities. First-line options include low-molecular-weight heparins (LMWHs), direct oral anticoagulants, and aspirin. Second-line options consist of unfractionated heparin (UFH), fondaparinux, and warfarin. For most patients undergoing knee or hip arthroplasty, the initial agents recommended for the early perioperative period are LMWHs (enoxaparin or dalteparin) or direct oral anticoagulants (rivaroxaban or apixaban). In the case of hip fracture surgery, LMWH is recommended as the preferred agent for the entire duration of prophylaxis. However, emerging factor XI(a) inhibitors, as revealed by a recent meta-analysis, have shown a substantial decrease in the occurrence of VTE and bleeding events among patients undergoing major orthopedic surgery. This discovery poses a challenge to the existing paradigm of anticoagulant therapy in this specific patient population and indicates that factor XI(a) inhibitors hold great promise as a potential strategy to be taken into serious consideration.

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Efficacy and Safety of Thromboprophylaxis Post-Orthopedic Surgery

Cited by 7 publications

References 34 publications

Comparison of the Therapeutic Effect of Different Anticoagulation Regimens after Total Hip Arthroplasty based on ERAS

Comparison of the Therapeutic Effect of Different Anticoagulation Regimens after Total Hip Arthroplasty based on ERAS

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

Venous Thromboembolism Prophylaxis in Major Orthopedic Surgeries and Factor XIa Inhibitors

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