Safety of Fondaparinux Versus Enoxaparin After TKA in Japanese Patients

Abstract

Fondaparinux and enoxaparin are useful for preventing venous thromboembolism after total knee arthroplasty (TKA), but both drugs have associated complications. The purpose of this study was to clarify the risks associated with use of these drugs in Japanese patients who underwent TKA.A total of 575 patients (935 knees) underwent TKA and were retrospectively reviewed; 277 patients (454 knees) were treated with fondaparinux and 298 patients (481 knees) were treated with enoxaparin. The authors investigated the incidences of deep venous thrombosis of the lower limbs and pulmonary embolism to evaluate venous thromboembolism, knee enlargement compared with the preoperative size, incidence of subcutaneous knee hematoma, and other complications. No significant differences were observed between the 2 drugs regarding the incidences of deep venous thrombosis and pulmonary embolism. However, fondaparinux use resulted in knee enlargement (P<.0005) and subcutaneous hematoma of the knee (P=.035) significantly more often than enoxaparin use. Conversely, enoxaparin use significantly caused the elevation of alanine aminotransferase (one of the liver enzymes) at a higher rate than fondaparinux (30.1% vs 8.3%, respectively; P<.0001). However, the increased alanine aminotransferase levels were transient, and no patient exhibited symptoms of abnormal liver function, such as jaundice or cutaneous pruritus.Fondaparinux and enoxaparin were both effective in preventing venous thromboembolism in Japanese patients undergoing elective TKA. However, both drugs had some adverse effects. It is important to be aware of these potential risks when prescribing these drugs.

Influence of Fondaparinux Versus Nadroparin Calcium Thromboprophylaxis on Clinical Parameters Following Total Knee Arthroplasty

“…Th is could lead to a conclusion that patients on fondaparinux have less need for postoperative allotransfusion due to the less intraoperative and early postoperative bleeding. A recent study by Hosaka et al 10 confi rmed the opinions from previous studies that excessive bleeding can be expected in patients undergoing surgery and receiving fondaparinux 5,12,[15][16][17] . In their study, Hosaka et al assessed the safety of fondaparinux versus enoxaparin after TKA in Japanese patients and concluded that thigh swelling and subcutaneous hematomas were greater in the fondaparinux group.…”

“…In their study, Hosaka et al assessed the safety of fondaparinux versus enoxaparin after TKA in Japanese patients and concluded that thigh swelling and subcutaneous hematomas were greater in the fondaparinux group. Th ey hypothesize that it is due to the same dose (2.5 mg daily) which all patients receive regardless of their body mass and the fact that Japanese patients are smaller than Western populations 10 . In our study, we found no diff erences in the knee or lower leg swelling between the groups, suggesting that no excessive bleeding was found in the fondaparinux group, which could partly be explained by the fact that most of our patients undergoing TKA were overweight with the mean BMI of 29.4 (range, 21.6-42) kg/m 2 .…”

“…Many studies have shown the benefi cial eff ects of fondaparinux in the prevention of thromboembolic diseases in orthopedic surgery 5,[9][10][11][12][13] . Our study results were in favor of these data, showing both fondaparinux and nadroparin calcium to be safe and effi cient during the fi rst 7 days after TKA.…”

Closed Suction Drainage Is Not Associated with Faster Recovery after Total Knee Arthroplasty

“…Interestingly, there was still a large amount of HBL after surgery, the mechanisms of which are considered to be extravasation into tissue and residual blood in the joint. Guyatt et al and Hosaka et al reported that use of antithrombotic drugs may result in more bleeding and swelling 29,30 . In our center, low-molecular weight heparin was administered 6 h after the surgery with the aim of achieving a balance between anti-coagulation and antifibrinolysis after administering TXA and possibly decreasing HBL 31 .…”

Efficacy and safety of venous thromboembolism prophylaxis with fondaparinux in women at risk after cesarean section

“…This anticoagulant has been widely used in clinical practice for patients undergoing orthopedic surgery and the periprocedural bleeding is low [ 10 ]. In Japan, patients were sometimes treated with 1.5 mg of fondaparinux instead of 2.5 mg of fondaparinux due to adverse effects including an increased incidence of subcutaneous knee hematoma [ 11 ].…”