Thromboembolic Prophylaxis for Total Knee Arthroplasty in Asian Patients: A Randomised Controlled Trial

Chin, Pak Lin; Amin, Muhammad Suhail; Yang, Kuang-Ying; Yeo, Seng Jin; Lo, Ngai Nung

doi:10.1177/230949900901700101

Cited by 63 publications

(77 citation statements)

References 30 publications

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“…LMWH 5 low-molecular-weight heparin. [31][32][33][34][35][36][37][38][39]47,48 and HFS. 49,50 Our analysis included all studies of LMWH vs no prophylaxis whether GCS were used in both groups because this would not affect the relative risk observed for LMWH.…”

Section: Baseline Risk For Major Bleeding Eventsmentioning

confidence: 99%

“…1,000 patients scheduled for THA [109][110][111] and TKA 31,112 : fi ve studies used a VFP, and two used an IPCD. We included studies in our analysis whether GCS were used in both treatment arms.…”

Section: Ipcds Vs Pharmacologic Thromboprophylaxisinitial Prophylaxismentioning

confidence: 99%

“…To estimate untreated bleeding risk, we fi rst determined the median major bleeding event rate from the placebo (or graduated compression stockings [GCS]) arm of LMWH trials and the Pulmonary Embolism Prevention (PEP) trial (subgroup that did not receive any heparin) because those trials were more recent. [30][31][32][33][34][35][36][37][38][39] [Section 1.3.1] Schematic of estimated incidence rates for LMWH and no prophylaxis for major orthopedic surgery used for this guideline. Additional example data are from observational studies (dashed line), which usually represents a cumulative incidence rate resulting from high rates of prophylaxis in the fi rst 7 to 14 days and low rates or no prophylaxis during the extended prophylaxis period.…”

Section: Baseline Risk For Major Bleeding Eventsmentioning

confidence: 99%

“…900 patients undergoing arthroplasty or HFS compared mechanical compression to no thromboprophylaxis. 31,66,[76][77][78][79] Six used an IPCD, and one a venous foot pump (VFP). 77 The risk of bias varied.…”

Section: Mechanical Interventions Vs No Prophylaxisinitial Prophylaxismentioning

confidence: 99%

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Prevention of VTE in Orthopedic Surgery Patients

Falck‐Ytter

Francis²,

Johanson³

et al. 2012

Chest

1,729

963

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Background: VTE is a serious, but decreasing complication following major orthopedic surgery. This guideline focuses on optimal prophylaxis to reduce postoperative pulmonary embolism and DVT. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: In patients undergoing major orthopedic surgery, we recommend the use of one of the following rather than no antithrombotic prophylaxis: low-molecular-weight heparin; fondaparinux; dabigatran, apixaban, rivaroxaban (total hip arthroplasty or total knee arthroplasty but not hip fracture surgery); low-dose unfractionated heparin; adjusted-dose vitamin K antagonist; aspirin (all Grade 1B); or an intermittent pneumatic compression device (IPCD) (Grade 1C) for a minimum of 10 to 14 days. We suggest the use of low-molecular-weight heparin in preference to the other agents we have recommended as alternatives (Grade 2C/2B), and in patients receiving pharmacologic prophylaxis, we suggest adding an IPCD during the hospital stay (Grade 2C). We suggest extending thromboprophylaxis for up to 35 days (Grade 2B). In patients at increased bleeding risk, we suggest an IPCD or no prophylaxis (Grade 2C). In patients who decline injections, we recommend using apixaban or dabigatran (all Grade 1B). We suggest against using inferior vena cava fi lter placement for primary prevention in patients with contraindications to both pharmacologic and mechanical thromboprophylaxis (Grade 2C). We recommend against Doppler (or duplex) ultrasonography screening before hospital discharge (Grade 1B). For patients with isolated lowerextremity injuries requiring leg immobilization, we suggest no thromboprophylaxis (Grade 2B). For patients undergoing knee arthroscopy without a history of VTE, we suggest no thromboprophylaxis (Grade 2B). Conclusions: Optimal strategies for thromboprophylaxis after major orthopedic surgery include pharmacologic and mechanical approaches. CHEST 2012; 141(2)(Suppl):e278S-e325SAbbreviations: DUS 5 Doppler (or duplex) ultrasonography; GCS 5 graduated compression stockings; HFS 5 hip fracture surgery; INR 5 international normalized ratio; IPCD 5 intermittent pneumatic compression device; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; PEP 5 Pulmonary Embolism Prevention trial; RCT 5 randomized controlled trial; RR 5 risk ratio; THA 5 total hip arthroplasty; TKA 5 total knee arthroplasty; UFH 5 unfractionated heparin; VFP 5 venous foot pump; VKA 5 vitamin K antagonist

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Section: Baseline Risk For Major Bleeding Eventsmentioning

confidence: 99%

Section: Ipcds Vs Pharmacologic Thromboprophylaxisinitial Prophylaxismentioning

confidence: 99%

Section: Baseline Risk For Major Bleeding Eventsmentioning

confidence: 99%

Section: Mechanical Interventions Vs No Prophylaxisinitial Prophylaxismentioning

confidence: 99%

See 2 more Smart Citations

Prevention of VTE in Orthopedic Surgery Patients

Falck‐Ytter

Francis²,

Johanson³

et al. 2012

Chest

1,729

963

View full text Add to dashboard Cite

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“…The side effects attributed to TXA include nausea, diarrhea, and occasional reports of arterial thrombosis, renal failure, which shows that it has a good safety profile [32]. The use of TXA is cost-efficient [33][34][35][36] and was also reflected in our study.…”

Section: Discussionmentioning

confidence: 67%

Tranexamic acid reduces blood loss in simultaneous bilateral total knee arthroplasty: a randomized control trial

Raviraj

Anand

Chakravarthy

et al. 2011

Eur J Orthop Surg Traumatol

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Total knee arthroplasty (TKA) is a common procedure, and bilateral TKA ensures cost efficiency. Bilateral TKA is associated with increased requirement of blood transfusion (BT). BT is associated with hazards, therefore be avoided. Tranexamic acid (TXA) has been suggested to reduce the BT, and the use of TXA in bilateral TKA appears sparse in literature. This study aimed at assessing the effect of TXA in such patients. This prospective randomized controlled trial evaluated the use of TXA in bilateral TKA. Pre-and postoperative hemoglobin (Hb) and packed cell volume (PCV), blood loss and BT, hospital stay, and the cost of TXA compared to blood transfusion were the measured variables. 175 patients (n = 88 TXA, n = 87 CTRL) completed the study. The patients in the control (CTRL) group on an average received 0.3 units and 0.07 in TXA group. The average blood loss in the TXA group was significantly less than the CTRL (P \ 0.0001). There was no significant difference in the perioperative complications, hospital stay in the two groups. The use of TXA reduces the postoperative blood loss. The allogenic BT requirement in patients undergoing bilateral TKA is significantly decreased. The routine use of this drug is cost-effective and reduces postoperative blood loss.

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