Thrombophylaxis with low-dose, short-term fondaparinux after elective hip surgery

Abstract

Some studies have cautioned about the possibility of bleeding complications with routine use of anticoagulants like fondaparinux (FPX) for thrombophylaxis after elective hip surgery. Overdosing or prolonged periods of anticoagulant use should be avoided. We trialed a new regimen using FPX and tranexamic acid (TA) to reduce the risk of bleeding complications while maintaining efficacy in preventing deep vein thrombosis (DVT). The present study evaluated the effectiveness and safety of this regimen in 391 consecutive patients. Each patient was assigned either the FPX group, administered a once-daily subcutaneous injection of 1.5 mg of FPX on postoperative days 2, 3, and 4; or the intermittent pneumatic compression (IPC) group, which used an IPC device continuously for 1-2 days with no administration of any anticoagulant drugs. Ultrasonography was performed to diagnose DVT in all patients. No cases of fatal or symptomatic pulmonary embolism were encountered in either group, but six patients (3.1 %) in the FPX group and nine patients (6.0 %) in the IPC group showed asymptomatic distal DVT. The incidence of DVT tended to be lower (p = 0.19), volumes of intraoperative (p < 0.01) and postoperative (p < 0.01) blood loss were significantly smaller, and hemoglobin level was significantly higher in the FPX group than in the IPC group (p < 0.01). Our new thrombophylactic regimen using FPX and TA appears effective and safe for use after elective hip surgery.

Incidences of deep vein thrombosis and major bleeding under the administration of fondaparinux for thromboprophylaxis after periacetabular osteotomy: a retrospective observational study

“…Bleeding complications associated with the use of fondaparinux have been described [ 7 , 11 ]. According to an after-market investigation of fondaparinux in Japan, the overall incidence of side effects following fondaparinux treatment was 1.13%, with serious side effects occurring in 0.27% of cases (bleeding from intestinal organs, 11 cases; bleeding from surgical sites, 33 cases) [ 21 ].…”

“…We have routinely administered fondaparinux for DVT prophylaxis in adult patients undergoing PAO. Although the administration of fondaparinux for DVT prophylaxis is useful, bleeding complications have been described [ 7 ]. In the present study, therefore, we aimed to investigate the incidences of DVT and major bleeding under the administration of fondaparinux for thromboprophylaxis after PAO.…”

Study on the safety and effectiveness of low-dose vs. regular-dose fondaparinux in preventing venous thromboembolism prophylaxis following total knee arthroplasty

“…In addition, pneumatic compression stockings were given to all patients after surgery. Patients were administered fondaparinux subcutaneously (1.5 or 2.5 mg) daily after 6 h of surgery for 9 days (8,9). All patients were treated with multimodal pain protocols like 40 mg parecoxib sodium was administered every 12 h and intravenous prophylactic antibiotics.…”