scholarly journals Venous Thromboembolism (VTE) Prophylaxis for Hip and Knee Arthroplasty: Changing Trends

2014 ◽  
Vol 7 (2) ◽  
pp. 108-116 ◽  
Author(s):  
Nicolaas C. Budhiparama ◽  
Matthew P. Abdel ◽  
Nadia N. Ifran ◽  
Sébastien Parratte
Keyword(s):  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Vte Prophylaxis ◽  
Changing Trends ◽  
Hip And Knee Arthroplasty

scholarly journals An Update on Venous Thromboembolism Rates and Prophylaxis in Hip and Knee Arthroplasty in 2020

Medicina ◽  
2020 ◽  
Vol 56 (9) ◽  
pp. 416 ◽  
Author(s):  
Daniel C. Santana ◽  
Ahmed K. Emara ◽  
Melissa N. Orr ◽  
Alison K. Klika ◽  
Carlos A. Higuera ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
High Volume ◽  
Optimal Choice ◽  
Slight Reduction ◽  
Vte Prophylaxis ◽  
Prophylactic Agent ◽  
Total Hip ◽  
Number Of Patients ◽  
Hip And Knee Arthroplasty

Patients undergoing total hip and knee arthroplasty are at high risk for venous thromboembolism (VTE) with an incidence of approximately 0.6–1.5%. Given the high volume of these operations, with approximately one million performed annually in the U.S., the rate of VTE represents a large absolute number of patients. The rate of VTE after total hip arthroplasty has been stable over the past decade, although there has been a slight reduction in the rate of deep venous thrombosis (DVT), but not pulmonary embolism (PE), after total knee arthroplasty. Over this time, there has been significant research into the optimal choice of pharmacologic VTE prophylaxis for individual patients, with the objective to reduce the rate of VTE while minimizing adverse side effects such as bleeding. Recently, aspirin has emerged as a promising prophylactic agent for patients undergoing arthroplasty due to its similar efficacy and good safety profile compared to other pharmacologic agents. However, there is no evidence to date that clearly demonstrates the superiority of any given prophylactic agent. Therefore, this review discusses (1) the current prevalence and trends in VTE after total hip and knee arthroplasty and (2) provides an update on pharmacologic VTE prophylaxis in regard to aspirin usage.

scholarly journals New Oral Anticoagulants for Venous Thromboembolism Prophylaxis in Total Hip and Knee Arthroplasty: A Systematic Review and Network Meta-Analysis

2022 ◽  
Vol 12 ◽  
Author(s):  
Yi-hu Yi ◽  
Song Gong ◽  
Tian-lun Gong ◽  
Ling-yun Zhou ◽  
Can Hu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Vte Prophylaxis ◽  
Risk Of Bleeding ◽  
Hip And Knee Arthroplasty ◽  
The Individual

Background: There is controversy over whether use of new oral anticoagulants (NOACs) associates with increased hemorrhage risk compared with non-NOAC. Meanwhile, determining which NOAC to use remains unclear. We aimed to summarize the evidence about NOACs in venous thromboembolism (VTE) prevention for patients with total hip and knee arthroplasty (THA and TKA).Methods: We searched RCTs assessing NOACs for VTE prophylaxis in adults undergoing THA and TKA in Medline, Embase, and Cochrane up to May 2021. Primary outcomes were VTE [included deep vein thrombosis (DVT) and pulmonary embolism (PE)], major VTE, and major bleeding. The rank probabilities of each treatment were summarized by the surface under the cumulative ranking curve area (SUCRA).Results: 25 RCTs with 42,994 patients were included. Compared with non-NOAC, NOACs were associated with a decreased risk of VTE (RR 0.68; 95% CI 0.55–0.84) and major VTE (RR = 0.52; 95% CI 0.35–0.76). Additionally, rivaroxaban, apixaban, and edoxaban but not dabigatran and betrixaban, did confer a higher efficacy compared with non-NOAC. None of the individual NOACs increased the risk of bleeding, while apixaban and betrixaban were even associated with a decreased risk of bleeding. In the comparison of different NOACs, rivaroxaban was associated with the greatest benefits in VTE (SUCRA = 79.6), DVT (SUCRA = 88.8), and major VTE (SUCRA = 89.9) prevention. Furthermore, subgroup analysis confirmed that NOACs associated with a higher efficacy tendency in patients with follow-up duration <60 days than follow-up duration ≥60 days.Conclusion: Evidence suggests that NOACs exert more benefits on VTE prophylaxis, and none of the individual NOACs increased hemorrhage compared with non-NOAC. Among various NOACs, rivaroxaban is recommended in patients with lower bleeding risk, and apixaban is recommended in patients with higher bleeding risk.Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021266890].

scholarly journals Clinical experience with fondaparinux in antiaggregate patients undergoing total hip and knee arthroplasty

2013 ◽  
pp. 179-182
Author(s):  
Guido Grappiolo ◽  
Marco Scardino ◽  
Giuseppe Mazziotta ◽  
Stefano Quaini ◽  
Corrado Lodigiani ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Antiplatelet Therapy ◽  
Knee Arthroplasty ◽  
Operative Therapy ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Effective Prophylaxis ◽  
Hip And Knee Arthroplasty ◽  
Total Knee ◽  
Deep Vein

Patients undergoing total hip arthroplasty or total knee arthroplasty have a high risk for post-operative venous thromboembolism. The current study addressed the use of fondaparinux post-operatively in 556 patients with antiplatelet therapy in order to prevent deep vein thrombosis as well as demonstrate efficacy in preventing arterial thrombotic events. Results provided evidence for a safe and effective prophylaxis strategy, involving the change from low molecular weight heparin pre-operatively to fondaparinux postoperatively. Also, fondaparinux proved effective as a unique post-operative therapy in the prevention of venous thromboembolism with no adverse effects, such as major bleeding or arterial thrombosis in patients with pre-operative antiplatelet therapy.

Association of Perioperative Red Blood Cell Transfusion With Symptomatic Venous Thromboembolism Following Total Hip and Knee Arthroplasty

2021 ◽  
Vol 36 (1) ◽  
pp. 325-330
Author(s):  
Aaron Jackson ◽  
Karan Goswami ◽  
Michael Yayac ◽  
Timothy L. Tan ◽  
Samuel Clarkson ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Blood Cell ◽  
Knee Arthroplasty ◽  
Red Blood Cell ◽  
Red Blood Cell Transfusion ◽  
Total Hip ◽  
Hip And Knee Arthroplasty

Venous Thromboembolism Chemoprophylaxis in Total Hip and Knee Arthroplasty

JBJS Reviews ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. e2-e2 ◽  
Author(s):  
Nikunj N. Trivedi ◽  
Steven J. Fitzgerald ◽  
Alvin H. Schmaier ◽  
Glenn D. Wera
Keyword(s):  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Total Hip ◽  
Hip And Knee Arthroplasty

Rivaroxaban Versus Enoxaparin for Venous Thromboembolism Prophylaxis after Hip and Knee Arthroplasty

2015 ◽  
Vol 30 (7) ◽  
pp. 1277-1280 ◽  
Author(s):  
Michael A. Charters ◽  
Nicholas B. Frisch ◽  
Nolan M. Wessell ◽  
Christopher Dobson ◽  
Clifford M. Les ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Thromboembolism Prophylaxis ◽  
Venous Thromboembolism Prophylaxis ◽  
Hip And Knee Arthroplasty

Aspirin Can Be Used as Prophylaxis for Prevention of Venous Thromboembolism After Revision Hip and Knee Arthroplasty

2016 ◽  
Vol 31 (10) ◽  
pp. 2237-2240 ◽  
Author(s):  
Gregory K. Deirmengian ◽  
Snir Heller ◽  
Eric B. Smith ◽  
Mitchell Maltenfort ◽  
Antonia F. Chen ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Hip And Knee Arthroplasty

Warfarin prophylaxis and venous thromboembolism in the first 5 days following hip and knee arthroplasty

2004 ◽  
Vol 92 (11) ◽  
pp. 1012-1017 ◽  
Author(s):  
Amir Jaffer ◽  
Jason Hurbanek ◽  
Nariman Morra ◽  
Daniel Brotman
Keyword(s):  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Odds Ratio ◽  
Case Control Study ◽  
Secondary Analysis ◽  
Case Control ◽  
Antithrombotic Effects ◽  
Hip And Knee Arthroplasty ◽  
Subcutaneous Enoxaparin ◽  
Control Study

SummaryMany orthopaedic surgeons use warfarin to prevent venous thromboembolism (VTE) following hip or knee arthroplasty. Since warfarin’s antithrombotic effects are delayed, we hypothesized that early VTE (occurring within 5 days post-operatively) would be more common in arthroplasty patients receiving warfarin monotherapy compared to those receiving enoxaparin. We performed a secondary analysis of a case-control study examining risk factors for post-operative thrombosis in postmenopausal women. We defined cases as patients who were diagnosed with thrombosis within 5 days of surgery. Controls without thrombosis were matched with cases by age, surgeon, year of surgery and surgical joint. 84 women with early post-operative thrombosis (cases) were matched with 206 controls. 18 cases (21.4%) had been prescribed warfarin monotherapy, compared with 7 controls (3.4%). 58 (69.1%) cases and 195 (94.7%) controls had been prescribed subcutaneous enoxaparin 30 mg twice daily, starting 12-24 hours after surgery. The odds ratio for any early thrombosis in patients receiving warfarin as opposed to enoxaparin 30 mg twice daily was 8.6 (p<0.0001). For proximal thrombosis, the odds ratio was 11.3 (p<0.0001). Multivariate analysis did not alter these findings. Warfarin’s delayed antithrombotic effects may not provide adequateVTE prophylaxis in the immediate post-operative setting. We suggest caution in employing warfarin monotherapy following joint arthroplasty.

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