Russian Experience in Rational Thromboprophylaxis in Traumatology and Orthopaedics

Abstract

Analysis of safety and efficacy of the currently marked peroral anticoagulants was performed in long term follow up of patients after large joints arthroplasty. Total number of 5025 patients after total knee arthroplasty and 5216 patients after total hip arthroplasty were examined. All patients were divided into groups depending on the prescribed anticoagulant. The course of anticoagulant therapy made up 35 days and 6 weeks after surgery, respectively. US examination of the veins of lower extremities was performed to all patients prior to and on day 5 after operation. In patients on Dabigatran the rate of clinically significant deep vein thrombosis was lower than in group of patients on Rivaroxaban and Apixaban, but the rate of postoperative hematomas in lust two groops was higher.

Keywords

thromboprophylaxis / arthroplasty / peroral anticoagulants

References

[1] Профилактика венозных тромбоэмболических осложнений в травматологии и ортопедии. Российские клинические рекомендации. Травматология и ортопедия России. 2012; 1 (63): 1-24.

[2] Botella Gabriel F., Labios Gomez M., Balaguer Martinez J.V., Fernández Llopez A. Prevention of venous thromboembolism: unfractionated heparins and low-molecular weight heparins. Analysis of these 2 options. An. Med. Interna. 2009; 16 (11): 590-600 [In Spanish].

[3] Camporese G., Bernardi E., Prandoni P., Noventa F., Verlato F., Simioni P. Low-molecular-weight heparin versus compression stocking for thromboprohylaxis after knee arthroscopy: a randomized trial. Ann. Intern Med. 2008; 149 (2): 73-82.

[4] Cohen A.T., Agnelli G., Anderson F.A., Arcelus J.I., Bergqvist D., Brecht J.G., Greer I.A., Heit J.A., Hutchinson J.L., Kakkar A.K., Mottier D., Oger E., Samama M.M., Spannagi M., VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb. Haemost. 2007; 98 (4): 756-64.

[5] Carneiro J.L., Targueta G.P., Marino L.O. Evalution of venous thromboembolism prophylaxis in a high complexity hospital. Rev. Col. Bras. Cir. 2010; 37 (3): 204-10.

[6] Dahl O.E. Efficacy and safety profile of dabigatran etexilate compared with enoxaparin in primary venous thromboembolism prevention after total knee or hip replacement surgery in patients over 75 years. Blood. 2008; 112: 167.

[7] Eikelboom J.W., Quinlan D.J., Douketis J.D. Extended duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomized trials. Lancet. 2002; 358: 9-15.

[8] Erikkson B., Kakkar A.K., Turpie A.G., Gent M., Bandel T.J., Homering M. et al. Oral rivaroxaban for the prevention of symptomatic venous thromboembolism after elective hip and knee replacement. J. Bone Joint Surg. Br. 2009; 91 (5): 636-44.

[9] Hill J., Treasure T. Reducing the risk of venous thromboembolism in patients admitted to hospital: summary of the NICE guideline. Heart. 2010; 96 (11): 879-82.

[10] NICE Clinical Guideline 46. Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and embolism) in inpatients undergoing surgery. 2007 Available at www.guidance.nice.org.uk/CG46

[11] Gussoni G., Campanini M., Silingardi M., Scannapieco G., Mazzone A., Magni G. et al. In-hospital symptomatic venous thromboembolism and antithrombotic prophylaxis in Internal Medicine. Findings from a multicenter, prospective study. Thromb. Haemost. 2009; 101 (5): 893-901.

[12] Samama C.M., Ravaud P., Parent F., Barré J., Mertl P., Mismetti P. Epidemiology of venous thromboembolism after lower limb arthroplasty: the FOTO study. J. Thromb. Haemost. 2007: 5 (12): 2360-7.

[13] Huisman M.V., Quinlan D.J., Dahl O.E., Schulman S. Enoxaparin versus dabigatran or rivaroxaban for thromboprophylaxis after hip or knee arthroplasty results of separate pooled analyses of phase III multicenter randomized trials. Cardiovasc. Qual. Outcomes. 2010; 3 (6): 652-60.

[14] Geerts W.H., Bergqvist D., Pineo G.F., Heit J.A., Samama C.M., Lassen M.R., Colwell C.W. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. 8th ed. Chest. 2008; 133 (6 Suppl): 381S-453S.

[15] Pellegrini Jr V.D., Sharrock N.E., Paiement G.D., Morris R., Warwick D.J. Venous thromboembolic disease after total hip and knee arthroplasty: current perspectives in a regulated environment. AAOS Instr. Course Lect. 2008; 57: 637-61.

[16] Ramos J., Perrotta C., Badariotti G., Berenstein G. Interventions for preventinng venous thromboembolism in adults undergoing knee arthroscopy. Cochrane Database Syst Rev. 2007; 2: CD005259.

[17] Sandoval-Chagoya G.A., Laniado-Laborin R. Deep vein thrombosis prophylaxis. Rev. Med. Inst. Mex. Seguro Soc. 2013; 51 (6): 688-91.

[18] Warwick D., Dahl O.E., Fisher W.D. Orthopaedic thromboprophylaxis: limitations of current guidelines. J. Bone Joint Surg. 2008; 90 (2): 127-32.

[19] Rosecher N., Albaladejo P. A new approach with anticoagulant development: tailoring anticoagulant therapy with dabigatran etexilate according to patient risk. Expert. Opin. Pharmacother. 2012; 13 (2): 217-26. doi: 10.1517/14656566.2012.648614.

[20] Turpie A.G., Haas S., Kreutz R., Mantovani L.G., Pattanayak C.W., Holberg G., Jamal W., Schmidt A. et al. A non-interventional comparison of rivaroxaban with standard of care for thromboprophylaxis after major orthopaedic surgery in 17,701 patients with propensity score adjustment. Thromb. Haemost. 2014; 111 (1): 94-102.

[21] Lassen M.R., Gallus A., Borris L.C. et al. Apixaban versus enoxaparin for thromboprophylaxis after hip replacement. N. Engl. J. Med. 2010; 363: 2487-98.

[22] A. Gomez-Outes. Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or knee replacement: systematic review, meta-analysis, and indirect treatment comparisons. BMJ, 2012; 344: e. 36-75

RIGHTS & PERMISSIONS

Eco-Vector