scholarly journals Postoperative Thromboprophylaxis With New Oral Anticoagulants is Superior to LMWH in Hip Arthroplasty Surgery

2019 ◽  
Vol 477 (6) ◽  
pp. 1335-1343 ◽  
Author(s):  
Piotr Kasina ◽  
Alexander Wall ◽  
Lasse J. Lapidus ◽  
Ola Rolfson ◽  
Johan Kärrholm ◽  
...  
2012 ◽  
Vol 03 (03) ◽  
pp. 121-125
Author(s):  
I. Pabinger ◽  
C. Ay

SummaryCancer is a major and independent risk factor of venous thromboembolism (VTE). In clinical practice, a high number of VTE events occurs in patients with cancer, and treatment of cancerassociated VTE differs in several aspects from treatment of VTE in the general population. However, treatment in cancer patients remains a major challenge, as the risk of recurrence of VTE as well as the risk of major bleeding during anticoagulation is substantially higher in patients with cancer than in those without cancer. In several clinical trials, different anticoagulants and regimens have been investigated for treatment of acute VTE and secondary prophylaxis in cancer patients to prevent recurrence. Based on the results of these trials, anticoagulant therapy with low-molecular-weight heparins (LMWH) has become the treatment of choice in cancer patients with acute VTE in the initial period and for extended and long-term anticoagulation for 3-6 months. New oral anticoagulants directly inhibiting thrombin or factor Xa, have been developed in the past decade and studied in large phase III clinical trials. Results from currently completed trials are promising and indicate their potential use for treatment of VTE. However, the role of the new oral thrombin and factor Xa inhibitors for VTE treatment in cancer patients still has to be clarified in further studies specifically focusing on cancer-associated VTE. This brief review will summarize the current strategies of initial and long-term VTE treatment in patients with cancer and discuss the potential use of the new oral anticoagulants.


2015 ◽  
Vol 10 (3) ◽  
pp. 208-216 ◽  
Author(s):  
Ian Pinto ◽  
Anshu Giri ◽  
Umbreen Arshad ◽  
Ajeet Gajra

2020 ◽  
Vol 41 (S1) ◽  
pp. s135-s136
Author(s):  
Flávio Souza ◽  
Braulio Couto ◽  
Felipe Leandro Andrade da Conceição ◽  
Gabriel Henrique Silvestre da Silva ◽  
Igor Gonçalves Dias ◽  
...  

Background: In 7 hospitals in Belo Horizonte, a city with >3,000,000 inhabitants, a survey was conducted between July 2016 and June 2018, focused on surgical site infection (SSI) in patients undergoing arthroplasty surgery procedures. The main objective is to statistically evaluate such incidences and enable a study of the prediction power of SSI through pattern recognition algorithms, the MLPs (multilayer perceptron). Methods: Data were collected on SSI by the hospital infection control committees (CCIHs) of the hospitals involved in the research. All data used in the analysis during their routine SSI surveillance procedures were collected. The information was forwarded to the NOIS (Nosocomial Infection Study) Project, which used SACIH automated hospital infection control system software to collect data from a sample of hospitals participating voluntarily in the project. After data collection, 3 procedures were performed: (1) a treatment of the database collected for the use of intact samples; (2) a statistical analysis on the profile of the hospitals collected; and (3) an assessment of the predictive power of 5 types of MLP (backpropagation standard, momentum, resilient propagation, weight decay, and quick propagation) for SSI prediction. MLPs were tested with 3, 5, 7, and 10 hidden layer neurons and a database split for the resampling process (65% or 75% for testing and 35% or 25% for validation). The results were compared by measuring AUC (area under the curve; range, 0–1) presented for each of the configurations. Results: Of 1,246 records, 535 were intact for analysis. We obtained the following statistics: the average surgery time was 190 minutes (range, 145–217 minutes); the average age of the patients was 67 years (range, 9–103); the prosthetic implant index was 98.13%; the SSI rate was 1.49%, and the death rate was 1.21%. Regarding the prediction power, the maximum prediction power was 0.744. Conclusions: Despite the considerable loss rate of almost 60% of the database samples due to the presence of noise, it was possible to perform relevant sampling for the profile evaluation of hospitals in Belo Horizonte. For the predictive process, some configurations have results that reached 0.744, which indicates the usefulness of the structure for automated SSI monitoring for patients undergoing hip arthroplasty surgery. To optimize data collection and to enable other hospitals to use the SSI prediction tool (available in www.sacihweb.com ), a mobile application was developed.Funding: NoneDisclosures: None


2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Lisa M. Baumann Kreuziger ◽  
Joseph C. Keenan ◽  
Colleen T. Morton ◽  
David J. Dries

Ease of dosing and simplicity of monitoring make new oral anticoagulants an attractive therapy in a growing range of clinical conditions. However, newer oral anticoagulants interact with the coagulation cascade in different ways than traditional warfarin therapy. Replacement of clotting factors will not reverse the effects of dabigatran, rivaroxaban, or apixaban. Currently, antidotes for these drugs are not widely available. Fortunately, withholding the anticoagulant and dialysis are freqnently effective treatments, particularly with rivaroxaban and dabigatran. Emergent bleeding, however, requires utilization of Prothrombin Complex Concentrates (PCCs). PCCs, in addition to recombinant factor VIIa, are used to activate the clotting system to reverse the effects of the new oral anticoagulants. In cases of refractory or emergent bleeding, the recommended factor concentrate in our protocols differs between the new oral anticoagulants. In patients taking dabigatran, we administer an activated PCC (aPCC) [FELBA] due to reported benefit in human in vitro studies. Based on human clinical trial evidence, the 4-factor PCC (Kcentra) is suggested for patients with refractory rivaroxaban- or apixaban-associated hemorrhage. If bleeding continues, recombinant factor VIIa may be employed. With all of these new procoagulant agents, the risk of thrombosis associated with administration of factor concentrates must be weighed against the relative risk of hemorrhage.


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