Prolonged Thromboprophylaxis Following Hip Replacement Surgery – Results of a Double-blind, Prospective, Randomised, Placebo-controlled Study with Dalteparin (Fragmin®)

1997 ◽  
Vol 77 (01) ◽  
pp. 026-031 ◽  
Author(s):  
O E Dahl ◽  
G Andreassen ◽  
T Aspelin ◽  
C Müller ◽  
P Mathiesen ◽  
...  
Keyword(s):  
Hip Replacement ◽  
Group Versus ◽  
Treated Group ◽  
Controlled Study ◽  
Double Blind ◽  
Once Daily ◽  
Randomised Study ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
To Receive

SummaryDiscontinuation of thromboprophylaxis a few days after surgery may unmask delayed hypercoagulability and contribute to late formation of deep venous thrombosis (DVT). To investigate whether thromboprophylaxis should be prolonged beyond the hospital stay, a prospective, double-blind randomised study was conducted in 308 patients. All patients received initial thromboprophylaxis with dalteparin, dextran and graded elastic stockings. On day 7, patients were randomised to receive dalteparin (Fragmin®) 5000IU once daily, or placebo, for 4 weeks. All patients were subjected to bilateral venography, perfusion ventilation scintigraphy and chest X-ray on days 7 and 35. Patients with venographically verified proximal DVT on day 7 were withdrawn from the randomised study to receive anticoagulant treatment. The overall prevalence of DVT on day 7 was 15.9%. On day 35, the prevalence of DVT was 31.7% in placebo-treated patients compared with 19.3% in dalteparin-treated patients (p = 0.034). The incidence of DVT from day 7 to day 35 was 25.8% in the placebo-treated group versus 11.8% in the dalteparin-treated group (p = 0.017). The incidence of symptomatic pulmonary embolism (PE) from day 7 to day 35 was 2.8% in the placebo-treated group compared with zero in the dalteparin-treated group. This included one patient who died from PE. No patients experienced serious complications related to the injections of dalteparin or placebo. This study shows that prolonged thromboprophylaxis with dalteparin, 5000 IU, once daily for 35 days significantly reduces the frequency of DVT and should be recommended for 5 weeks after hip replacement surgery.

Etoricoxib Provides Analgesic Efficacy to Patients After Knee or Hip Replacement Surgery: A Randomized, Double-Blind, Placebo-Controlled Study

2005 ◽  
Vol 101 (4) ◽  
pp. 1104-1111 ◽  
Author(s):  
G Lynn Rasmussen ◽  
Kerstin Malmstrom ◽  
Michael H. Bourne ◽  
Maurice Jove ◽  
Steven M. Rhondeau ◽  
...  
Keyword(s):  
Hip Replacement ◽  
Analgesic Efficacy ◽  
Controlled Study ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Replacement Surgery ◽  
Hip Replacement Surgery

scholarly journals Aspirin-Persantin Prophylaxis in Elective total hip Replacement

1977 ◽  
Author(s):  
A.J. Silvergleid ◽  
R. Bernstein ◽  
D.S. Burton ◽  
J.B. Tanner ◽  
J.F. Silverman ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Treated Group ◽  
Control Group ◽  
Double Blind ◽  
Total Hip ◽  
Blind Area ◽  
Effective Prophylaxis ◽  
Clinically Significant ◽  
To Receive

A prospective, double-blind clinical study was performed to evaluate the combination of dipyridamole(Persantin)225 mg/day and acetyl salicyclic acid (ASA) 1 g/day prophylaxis of post-operative venous thromboembolism in elective total hip replacement. Patients were stratified according to age, and randomly assigned to receive drug or placebo. All patients were followed with 125I-labelledfibrinogen scanning for one week post-operatively, or until fully mobile. Venography was performed in 67/129 patients; in 27 patients the venogram was obtained to confirm a positive fibrinogen scan, in 40 patients an elective venogram was obtained on the 7th post-operative day to evaluate the operated thigh (a blind area for scanning). Thrombosis (by scan or venogram) was found in 16/66(24%) in the control group, and in 21/63(33%) in the treated group. Overall incidence was 37/129 (29%). Correlation of scan with venography was 90%. There were no clinically significant pulmonary emboli in either group. We conclude that the combination of ASA and dipridamole as given in this study is not effective prophylaxis in elective total hip replacement.

scholarly journals Evaluation of the efficacy and safety of etoricoxib in the treatment of hemophilic arthropathy

Blood ◽  
2006 ◽  
Vol 107 (5) ◽  
pp. 1785-1790 ◽  
Author(s):  
Christos Tsoukas ◽  
M. Elaine Eyster ◽  
Sumiko Shingo ◽  
Saurabh Mukhopadhyay ◽  
Karen M. Giallella ◽  
...  
Keyword(s):  
Global Assessment ◽  
Disease Status ◽  
Controlled Study ◽  
Pain Patient ◽  
Double Blind ◽  
End Points ◽  
Once Daily ◽  
Upper Respiratory Infection ◽  
Hemophilic Arthropathy ◽  
To Receive

This 2-part, double-blind, placebo-controlled study was conducted to determine the safety and efficacy of etoricoxib, a COX-2 selective inhibitor, for the treatment of hemophilic arthropathy. In part 1 (6 weeks), 102 patients (≥ 12 years old) with hemophilic arthropathy were randomized to receive 90 mg etoricoxib once daily or placebo (1:1 ratio). In part 2 (6 months), 51 patients taking placebo in part 1 were randomized to receive 90 mg etoricoxib or 25 mg rofecoxib once daily; patients taking etoricoxib in part 1 continued the same treatment. Efficacy end points included Patient Assessment of Arthropathy Pain, Patient Global Assessment of Arthropathy Disease Status, and Investigator Global Assessment of Arthropathy Disease Status. Safety was evaluated at each study visit. Etoricoxib provided significant improvement in all end points versus placebo (P < .001). Fewer patients taking etoricoxib discontinued due to a lack of efficacy versus placebo (P = .048). During part 2, efficacy was maintained; etoricoxib and rofecoxib demonstrated similar results. The most common adverse experiences were upper respiratory infection and headache. The incidence of joint bleeding during part 1 was similar between etoricoxib (66.7%) and placebo (72.6%) and during part 2 between etoricoxib (77.0%) and rofecoxib (78.9%). We conclude that etoricoxib provided superior efficacy versus placebo for the treatment of hemophilic arthropathy and was generally safe and well tolerated.

scholarly journals SR123781A: A New Once-Daily Synthetic Oligosaccharide Anticoagulant for Thromboprophylaxis After Total Hip Replacement Surgery

2008 ◽  
Vol 51 (15) ◽  
pp. 1498-1504 ◽  
Author(s):  
Michael R. Lassen ◽  
Ola Dahl ◽  
Patrick Mismetti ◽  
Dirk Zielske ◽  
Alexander G.G. Turpie
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Once Daily ◽  
Total Hip ◽  
Replacement Surgery ◽  
Hip Replacement Surgery

scholarly journals Effects of B-cell directed therapy on the preclinical stage of rheumatoid arthritis: the PRAIRI study

2018 ◽  
Vol 78 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Danielle M Gerlag ◽  
Mary Safy ◽  
Karen I Maijer ◽  
Man Wai Tang ◽  
Sander W Tas ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
At Risk ◽  
B Cell ◽  
Placebo Treatment ◽  
Treated Group ◽  
Controlled Study ◽  
Single Infusion ◽  
Double Blind ◽  
To Receive

ObjectivesWe explored the effects of B-cell directed therapy in subjects at risk of developing autoantibodypositive rheumatoid arthritis (RA), who never experienced inflammatory arthritis before, and explored biomarkers predictive of arthritis development.MethodsIndividuals positive for both anti-citrullinated peptide antibodies and rheumatoid factor but without arthritis were included in a randomised, double-blind, placebo-controlled study to receive a single infusion of 1000 mg rituximab or placebo.ResultsEighty-one individuals received treatment and were followed up for a mean of 29.0 (0–54) months, during which 30/81 (37%) individuals developed arthritis. The observed risk of developing arthritis in the placebo-treated group was 40%, which was decreased by 55% (HR 0.45, 95% CI 0.154 to 1.322) in the rituximab-treated group at 12 months. Rituximab treatment caused a delay in arthritis development of 12 months compared with placebo treatment at the point when 25% of the subjects had developed arthritis (p<0.0001). Erythrocyte sedimentation rate and the presence of anti-citrullinated α-enolase peptide 1 at baseline were significant predictors of arthritis development.ConclusionsA single infusion of 1000 mg rituximab significantly delays the development of arthritis in subjects at risk of developing RA, providing evidence for the pathogenetic role of B cells in the earliest, prearthritis stage of autoantibody positive RA.

Patient-Controlled Analgesia versus Patient-Controlled Analgesia plus Continuous Infusion after Hip Replacement Surgery

1996 ◽  
Vol 30 (3) ◽  
pp. 224-227 ◽  
Author(s):  
Maureen A Smythe ◽  
Margie B Zak ◽  
Maureen P O'Donnell ◽  
Randy F Schad ◽  
Carl F Dmuchowski
Keyword(s):  
Adverse Effects ◽  
Pain Intensity ◽  
Continuous Infusion ◽  
Hip Replacement ◽  
Patient Controlled Analgesia ◽  
Teaching Institution ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Patient Reported ◽  
To Receive

OBJECTIVE: To compare the efficacy and adverse effect profile of patient-controlled analgesia (PCA) versus PCA plus continuous infusion (PCACI) after hip replacement surgery. DESIGN: Prospective, randomized, open pilot study. SETTING: Large teaching institution. PARTICIPANTS: Thirty-four patients undergoing hip replacement or revision of hip replacement surgery. INTERVENTIONS: Patients were randomized to receive PCA morphine: 1 mg with 6-minute lockout, or PCACI, using the same dose, with a 0.5–1 mg/h continuous infusion. Pain intensity, sedation, narcotic use, injection/attempt ratio (I/A), and adverse effects were assessed. RESULTS: No significant differences in pain intensity were identified. Morphine use was not different between groups: PCA 61.8 ± 35.0 and PCACI 74.2 ± 54.9 mg (p = 0.394). A trend toward an increased 12-hour I/A ratio was evident in the PCACI group: PCA 0.73 ± 0.18 and PCACI 0.86 ± 0.17 (p = 0.073). Patient-reported adverse effects, sedation, and inability to sleep secondary to pain occurred similarly. Eight of 18 PCACI patients required discontinuation of either the continuous infusion mode or of PCA therapy entirely secondary to adverse effects. CONCLUSIONS: When compared with PCA therapy, PCACI was not associated with improved pain control and more patients receiving PCACI required discontinuation of therapy secondary to adverse effects.

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