The role of newer anticoagulants in prevention of deep vein thrombosis following joint replacements

Background: Deep vein thrombosis following orthopedic surgeries particularly hip and knee arthroplasty is due to the accompanying blood vessel trauma, venous stasis, coagulation activation and older age in most of the patients. This study aims to study the efficacy of newer anticoagulants such as direct thrombin and direct factor Xa inhibitors in prevention of deep vein thrombosis (DVT) following arthroplasties.Methods: Tablet Apixaban 2.5 mg twice daily was administered for 15 days following total knee replacement (TKR) and 30 days following total hip replacement (THR) or hemiarthroplasties. Patients were examined clinically and radiologically with colour doppler of both lower limbs from 5th-13th and 30th-42th day postoperatively during follow up.Results: Only 3 out of 53 patients who underwent hip/knee arthroplasty developed DVT (p <0.05) which were found to be significant. Conclusions: The prevention of DVT in hip and knee arthoplasty using newer anticoagulant Apixaban was more efficacious, well tolerated with low rate of bleeding.

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Is Obesity Associated With Increased Risk of Deep Vein Thrombosis or Pulmonary Embolism After Hip and Knee Arthroplasty? A Large Database Study

Clinical Orthopaedics and Related Research ◽

10.1097/corr.0000000000000615 ◽

2019 ◽

Vol 477 (3) ◽

pp. 523-532 ◽

Cited By ~ 14

Author(s):

Matthew Sloan ◽

Neil Sheth ◽

Gwo-Chin Lee

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Knee Arthroplasty ◽

Large Database ◽

Database Study ◽

Vein Thrombosis ◽

Increased Risk ◽

Hip And Knee Arthroplasty ◽

Deep Vein

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Predictive value of preoperative erythrocyte electrophoresis exponent for acute deep vein thrombosis after total knee arthroplasty in patients with knee osteoarthritis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02020-x ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Dai Xiaoyu ◽

Chen Kai ◽

Huang Zhihui ◽

Li Huan ◽

Zhang Naidong ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Deep Vein Thrombosis ◽

Knee Osteoarthritis ◽

Knee Arthroplasty ◽

Predictive Value ◽

Lower Limbs ◽

Vein Thrombosis ◽

Post Surgery ◽

Total Knee ◽

Deep Vein

Abstract Background Hemorheological parameters have been confirmed to be related with deep vein thrombosis (DVT). This study is aimed to verify whether preoperative erythrocyte electrophoresis exponent was associated with postoperative deep vein thrombosis (DVT) risk after total knee arthroplasty (TKA) in patients with primary knee osteoarthritis (KOA). Methods From March 2010 to May 2020, a total of 750 consecutive KOA patients who accepted unilateral TKA were enrolled. They were divided into DVT (176 patients) and non-DVT groups (574 patients) according to the examination results of the Doppler ultrasound of deep veins in both lower limbs on postoperative day 3. The Chi-square test, Student’s t test, and multivariate logistic regression analysis were performed to analyze the correlation of erythrocyte electrophoresis exponent and DVT risk in 2 groups. Receiver operating characteristic (ROC) analysis was used to assess predictive value of erythrocyte electrophoresis exponent for DVT. Results A low erythrocyte electrophoresis exponent was a significant risk factor for DVT in patients with primary KOA (p < 0.05), especially in females when stratified by gender (p < 0.05). Conclusions The findings suggest that lower erythrocyte electrophoresis before surgery may be independently associated with a higher post-surgery DVT risk in primary KOA patients. It is necessary to optimize prophylaxis strategies for DVT in these patients.

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Physician compliance with guidelines for deep-vein thrombosis prevention in total hip and knee arthroplasty

Current Medical Research and Opinion ◽

10.1185/030079907x242746 ◽

2008 ◽

Vol 24 (1) ◽

pp. 87-97 ◽

Cited By ~ 88

Author(s):

Richard J. Friedman ◽

Alexander S. Gallus ◽

Fred D. Cushner ◽

Gordon Fitzgerald ◽

Frederick A. Anderson ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Knee Arthroplasty ◽

Total Hip ◽

Vein Thrombosis ◽

Physician Compliance ◽

Hip And Knee Arthroplasty ◽

Deep Vein

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Symptomatic In-Hospital Deep Vein Thrombosis and Pulmonary Embolism Following Hip and Knee Arthroplasty Among Patients Receiving Recommended Prophylaxis

JAMA ◽

10.1001/jama.2011.2029 ◽

2012 ◽

Vol 307 (3) ◽

Cited By ~ 144

Author(s):

Jean-Marie Januel ◽

Guanmin Chen ◽

Christiane Ruffieux ◽

Hude Quan ◽

James D. Douketis ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Knee Arthroplasty ◽

Vein Thrombosis ◽

Hip And Knee Arthroplasty ◽

Deep Vein

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Pathophysiological Processes Underlying the High Prevalence of Deep Vein Thrombosis in Critically Ill COVID-19 Patients

Frontiers in Physiology ◽

10.3389/fphys.2020.608788 ◽

2021 ◽

Vol 11 ◽

Author(s):

Sebastian Voicu ◽

Chahinez Ketfi ◽

Alain Stépanian ◽

Benjamin G. Chousterman ◽

Nassim Mohamedi ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Critically Ill ◽

Venous Blood ◽

Lower Limbs ◽

Venous Stasis ◽

Venous Blood Flow ◽

Mechanically Ventilated ◽

Vein Thrombosis ◽

High Prevalence ◽

Deep Vein

Coronavirus disease 2019 (COVID-19) predisposes to deep vein thrombosis (DVT) and pulmonary embolism (PE) particularly in mechanically ventilated adults with severe pneumonia. The extremely high prevalence of DVT in the COVID-19 patients hospitalized in the intensive care unit (ICU) has been established between 25 and 84% based on studies including systematic duplex ultrasound of the lower limbs when prophylactic anticoagulation was systematically administrated. DVT prevalence has been shown to be markedly higher than in mechanically ventilated influenza patients (6–8%). Unusually high inflammatory and prothrombotic phenotype represents a striking feature of COVID-19 patients, as reflected by markedly elevated reactive protein C, fibrinogen, interleukin 6, von Willebrand factor, and factor VIII. Moreover, in critically ill patients, venous stasis has been associated with the prothrombotic phenotype attributed to COVID-19, which increases the risk of thrombosis. Venous stasis results among others from immobilization under muscular paralysis, mechanical ventilation with high positive end-expiratory pressure, and pulmonary microvascular network injuries or occlusions. Venous return to the heart is subsequently decreased with increase in central and peripheral venous pressures, marked proximal and distal veins dilation, and drops in venous blood flow velocities, leading to a spontaneous contrast “sludge pattern” in veins considered as prothrombotic. Together with endothelial lesions and hypercoagulability status, venous stasis completes the Virchow triad and considerably increases the prevalence of DVT and PE in critically ill COVID-19 patients, therefore raising questions regarding the optimal doses for thromboprophylaxis during ICU stay.

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TREATMENT OF PROXIMAL DEEP VEIN THROMBOSIS (DVT) OF THE LOWER LIMBS BY CY 216* (LMWH) VERSUS UNFRACTIONATED HEPARIN (UFH)

10.1055/s-0038-1643236 ◽

1987 ◽

Cited By ~ 1

Author(s):

P Duroux

Keyword(s):

Body Weight ◽

Deep Vein Thrombosis ◽

Factor Xa ◽

Lower Limbs ◽

Proximal Deep Vein Thrombosis ◽

Bleeding Complications ◽

Antithrombotic Agent ◽

Randomised Study ◽

Vein Thrombosis ◽

Deep Vein

Preliminary clinical data showed CY 216 could be effective in the treatment of established DVT. Thus, we undertook an European collaborative controlled randomised study to assess the efficacy and tolerance of this new antithrombotic agent.140 patients presenting a proximal DVT of less than 5 days confirmed by phlebogram, are randomly allocated into 2 groups, one treated by UFH with constant pump infusion, at doses daily adapted to laboratory tests, the other one by CY 216 at a mean daily dosage of 450 aXa IC u** calculated at onset of treatment on body weight, administered daily by 2 sub-cutaneous injections during 10 days, without dosage adaptation whatever the lab. tests results.The efficacy is assessed on comparison on both phlebograms (Harder and Arnessen Indexes) and lung Scans performed before inclusion and after end of treatment. In addition, tolerance is appreciated on the incidence of bleeding complications. Furthermore, incidence of clinical DVT recurrence is assessed at 12th week.The present study is still in progress, 130 patients are included ; the preliminary results tend to show that CY 216 at fixed doses, body weight adapted, is an effective and safe treatment of proximal deep vein thrombosis.* CY 216 : FraxiparineR Choay** Axa IC u : anti-factor Xa Institut Choay unit.

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