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 Current status survey of the extramural hospital management of venous thromboembolism after total hip and knee arthroplasty in China

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kai Tong ◽  
Hankun Liu ◽  
Jun Qin ◽  
Zhengqi Pan ◽  
Yangfan Shangguan ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Patient Compliance ◽  
Knee Arthroplasty ◽  
Oral Anticoagulants ◽  
Hospital Management ◽  
Current Status ◽  
Anticoagulation Management ◽  
Survey Tool ◽  
Total Hip

Abstract Background Venous thromboembolism (VTE) is a potentially fatal complication after arthroplasty. Numerous prophylactic strategies and studies to reduce VTEs have focused on the duration of the hospital stay and on few extramural hospitals. This study aimed to investigate extramural hospital management of VTE after total hip/knee arthroplasty (THA/TKA) in China with a novel survey tool. Methods A total of 180 patients undergoing arthroplasty, including 68 THA patients and 112 TKA patients, were enrolled in this study. All patients received anticoagulant treatment management. A survey querying VTE management and adherence, such as therapy information, understanding of anticoagulation, satisfaction with the ability of medical staff, and satisfaction with health care costs, was administered by a questionnaire (TKA/THA Patients’ Experience with Anticoagulation in the Post-discharge Period) for quality improvement. Results The average age of the patients was 65.27 ± 13.62 years. All patients knew their follow-up times. 85 % of them were suggested that re-examine at the next 14 days, and the others at the next 28 days. All patients continued to visit the orthopaedic clinic after discharge without choosing other types of outpatient services, such as an anticoagulant clinic or home visit with a nurse/pharmacist or remote evaluation by telephone. A total of 96.6 % of all patients used new oral anticoagulants, and the most common treatment duration was 2–4 weeks (93.3 %). 48 % informed their physicians that they were taking anticoagulation medications when they visited ophthalmology, dentistry, dermatology, and other departments. The overall rate of satisfaction with anticoagulation management was 81.67 %, and 6.67 % of patients were not unsatisfied with their medical expenses. Patient compliance decreased with increasing follow-up time. Continuous follow-ups after discharge significantly improved patient compliance. Conclusions These results elucidate how we can improve the quality of anticoagulation. Continuous follow-up appointments for 30 days after discharge, especially for individuals over 65 years old, significantly improved patient satisfaction and reduced the incidence of VTE and medical costs.

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.

Abstract MP13: Comparative Effectiveness of Direct Oral Anticoagulants and Warfarin on Risk of Bleeding Resulting in Hospitalization Among Venous Thromboembolism Patients

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Pamela L Lutsey ◽  
Neil A Zakai ◽  
Richard F MacLehose ◽  
Faye L Norby ◽  
Rob F Walker ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Comparative Effectiveness ◽  
Proportional Hazards ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Final Analysis ◽  
Bleeding Risk ◽  
Cox Proportional Hazards ◽  
Bleeding Events ◽  
Risk Of Bleeding

Background: Direct oral anticoagulants (DOACs), including rivaroxaban, dabigatran, apixaban and edoxaban, have been approved as alternatives to warfarin for the primary treatment of venous thromboembolism (VTE). However, understanding of their comparative effectiveness in practice-based populations is limited. Objective: Among anticoagulant-naïve VTE patients, estimate the association of type of oral anticoagulant (OAC) with the rate of bleeding resulting in hospitalization. Methods: Patients with VTE and prescription for an OAC were identified from the US Truven Health MarketScan® Commercial and Medicare Supplemental databases for the period from 2011-2015. Hospitalization related to bleeding events (inclusive of intracranial, gastrointestinal and other) was defined using a validated algorithm. In head-to-head comparisons, initiators of a specific OAC were matched with up to 5 initiators of the comparing OAC by age, sex, and time since database enrollment. Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (95%CI) for bleeding by OAC, adjusted for age, sex, and a comorbidity propensity score (created using prevalence of 20 common diagnoses and procedures). Results: The final analysis included 83,831 VTE patients who were 49.9% female and on average (standard deviation) 59.0 (16.0) years old. Of these, the initial OAC prescribed for 2,604 was apixaban, for 1,669 dabigatran, for 28,518 rivaroxaban, and for 48,514 warfarin. A total of 1,947 bleeding events occurred over an average of 13 months. Compared to new warfarin users, risk of bleeding was lower among patients initiating apixaban [HR (95%CI): 0.55 (0.36, 0.83)] and rivaroxaban [0.80 (0.72, 0.89)], but similar among new dabigatran users [0.96 (0.72, 1.27)]. In head-to-head DOAC comparisons, relative to rivaroxaban, risk of bleeding was lower among users of apixaban [0.57 (0.36, 0.89)] but similar for users of dabigatran [1.05 (0.73, 1.51)]. Due to low numbers we did not conduct analyses of edoxaban or a head-to-head comparison of dabigatran versus apixaban. Conclusion: In this practice-based population of 83,831 patients prescribed OACs for the treatment of VTE, subsequent risk of hospitalized bleeding was lowest among those prescribed apixaban, intermediate among those prescribed rivaroxaban, and highest among those prescribed warfarin and dabigatran. These data demonstrate that differences in bleeding risk exist by DOAC. While risk factors for bleeding might impact choice of warfarin versus the DOACs, the choice between DOACs may be less likely to be based on patient conditions.

Prophylaxis for venous thromboembolism in liver disease: a narrative literature review

2021 ◽  
Vol 19 (Sup10) ◽  
pp. S24-S31
Author(s):  
Alex Hadall
Keyword(s):  
Liver Disease ◽  
Venous Thromboembolism ◽  
Bleeding Risk ◽  
Assessment Tools ◽  
Decompensated Liver Disease ◽  
Vte Prophylaxis ◽  
Risk Of Bleeding ◽  
Number Of Patients ◽  
Increased Risk ◽  
Narrative Literature Review

Background: Patients with liver disease have traditionally been regarded as auto-anticoagulated against developing blood clots due to haemorrhage being regarded as the most significant haemostatic complication. More recently, there has been increasing recognition that hypercoagulability is a prominent aspect of cirrhosis, with an increasing number of patients developing thromboembolisms. When prescribing prophylactic low molecular weight heparin for prevention, clinicians are often concerned about the risk of bleeding, including gastrointestinal bleeding, specifically in those with decompensated liver disease and cirrhosis, due to the altered coagulopathy associated with these patients. Aim: The aim of this review was to assess if the use of prophylaxis in patients with liver disease is effective in the prevention of venous thromboembolism (VTE) and whether its use is related to an increase in bleeding episodes. Methods: A review of the literature was conducted to identify the incidence of VTE and bleeding in liver patients when given prophylactic VTE treatment. Results: The majority of evidence was inconclusive; however, the main emerging theme was that administering prophylaxis to patients with decompensated liver disease results in an increased risk of bleeding, while having little effect on reducing the risk of VTE development. Conclusion: The bleeding risk associated with VTE prophylaxis treatment and liver disease remains uncertain. Thus the ideal methods of medical prophylactic VTE prevention and monitoring in this patient population have not yet been determined. It is suggested that additional consideration should be given to serum albumin, platelet count and international normalised ratio, as well as renal function, in conjunction with risk assessment tools, when deciding whether to prescribe VTE prophylaxis or not.

Adherence with Injectibal Prophylaxis for Venous Thromboembolism (VTE) Following Total Hip (THR) and Total Knee (TKR) Replacement Surgery: Complete Registry.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 558-558
Author(s):  
William M Semchuk ◽  
David Backstein ◽  
John Stewart ◽  
Esmat Dessouki ◽  
Mary Kwan ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Acute Care ◽  
Knee Arthroplasty ◽  
Research Funding ◽  
Adherence Rate ◽  
Rehabilitation Unit ◽  
Vte Prophylaxis ◽  
Adherence Data ◽  
Care Ward

Abstract Abstract 558 Introduction: Patients undergoing major hip or knee arthroplasty are at high risk of venous thromboembolism (VTE). Guidelines recommend continuation of anticoagulant thromboprophylaxis for up to 35 days after hip and knee arthroplasty but little is known about adherence to injectable VTE prophylaxis. Objectives: 1) To describe adherence with injectable VTE prophylaxis following elective THR and TKR surgery 2) To analyze the factors impacting patient adherence. Methods: A prospective cohort study was conducted in 8 orthopaedic Canadian centres. Patients undergoing THR or TKR were enrolled at the time of discharge from the acute care ward. Patients prescribed with injectable prophylaxis at discharge from acute care ward / rehabilitation unit were contacted by phone within 6 weeks of discharge to collect data on their use of the prophylaxis. Overall Adherence (OA) was calculated as the weighted average of the adherence rate in the acute care ward/rehabilitation unit (inpatient) and the adherence rate for the follow-up phase (out patient). The inpatient adherence was based on records and the percent was calculated as doses administered divided by doses prescribed × 100. The outpatient adherence defines as adherence post discharge from the acute care ward/rehabilitation unit and was based on the results of the follow up call and the percent was calculated as number of syringes dispensed minus number of unused syringes left / total number of syringes that should have been injected out of the hospital as of the day of call × 100. Results: Of the 239 patients screened, 234 patients were enrolled. 198 were discharged directly home with a prescription for injectable prophylaxis and 36 patients went to a rehabilitation unit of whom 15 patients completed their injectable prophylaxis at the rehabilitation unit and 21 were subsequently discharged home with a prescription for injectable prophylaxis. Of the total 219 patients discharged home 9 (4.1%) were not reachable for the follow-up call. The inpatient adherence data were availabel for all 234 enrolled patients whereas outpatient adherence data were availabel for 210 patients. The calculated OA data for 225 patients represents the adherence of all enrolled patient who completed their injectable prophylaxis in the rehabilitation unit or discharged home and reachable for the follow-up call. Median duration of VTE prophylaxis at the follow-up phase was 10 days ranging from 1 to 45 days with 75% of the patients having duration of more than 1 week. The mean (±sd) age was 65.5 years (11.1) ranging from 23 to 91, 39.3% were males, 35.9% underwent total hip replacement. The median and interquartile range (IQ) for overall adherence was 96.6% (92.9-100.0), for inpatient adherence was 100.0% (100.0-100.0) and for outpatient adherence was 94.9% (88.9-100.0). The range of OA was from 16.7% to 180.0%. OA adherence below 80% in 6 (2.7%) patients was associated with cost of drugs (1), forgot (2), reason not specified (3). OA above 120% in 3 (1.3%) patients was associated with injecting extra syringes dispensed. Conclusion: The Complete Registry is the first Canadian registry that provides key real life data on adherence with injectable VTE prophylaxis and the factors impacting the adherence. Median inpatient and outpatient adherence was over 90% with few instances of under and over adherence. Disclosures: Semchuk: Pfizer Canada: Honoraria; Boehringer Ingelheim: Honoraria; Sanofi Aventis: Consultancy, Honoraria, Research Funding. Backstein:SanofiAventis: Honoraria. Stewart:Sanofi-Aventis Canada: Employment. Eikelboom:sanofi-aventis: Consultancy, Honoraria, Research Funding; Portola: Consultancy, Honoraria; GSK: Consultancy, Honoraria, Research Funding; BI: Consultancy, Honoraria; Bayer: Consultancy, Honoraria; BMS: Consultancy, Honoraria, Research Funding; Daiichi Sankyo: Consultancy, Honoraria.

scholarly journals How I assess and manage the risk of bleeding in patients treated for venous thromboembolism

Blood ◽  
2020 ◽  
Vol 135 (10) ◽  
pp. 724-734 ◽  
Author(s):  
Frederikus A. Klok ◽  
Menno V. Huisman
Keyword(s):  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Decision Rules ◽  
Bleeding Risk ◽  
Daily Practice ◽  
Bleeding Complications ◽  
Longitudinal Assessment ◽  
Risk Of Bleeding

Abstract For patients with venous thromboembolism (VTE), prediction of bleeding is relevant throughout the course of treatment, although the means and goal of this prediction differ between the subsequent stages of treatment: treatment initiation, hospital discharge, 3-month follow-up, and long-term follow-up. Even in the absence of fully established risk prediction schemes and outcome studies using a prediction scheme for treatment decisions, the present evidence supports screening for and targeting of modifiable risk factors for major bleeding, as well as the application of decision rules to identify patients at low risk of bleeding complications, in whom long-term anticoagulant treatment is likely safe. Moving forward, prediction tools need to be incorporated in well-designed randomized controlled trials aiming to establish optimal treatment duration in patients at high risk of recurrent VTE. Moreover, the benefit of their longitudinal assessment rather than application as stand-alone baseline assessments should be studied, because changes in bleeding risk over time likely constitute the best predictor of major bleeding. We provide the state-of-the-art of assessing and managing bleeding risk in patients with acute VTE and highlight a practical approach for daily practice illustrated by 2 case scenarios.

scholarly journals Bleeding risk in patients using oral anticoagulants submitted to surgical procedures in dentistry: a systematic review protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e019161 ◽  
Author(s):  
Rogério Heládio Lopes Motta ◽  
Cristiane de Cássia Bergamaschi ◽  
Natalia Karol de Andrade ◽  
Caio Chaves Guimaraes ◽  
Juliana Cama Ramacciato ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Procedures ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Secondary Outcome ◽  
Cochrane Central Register ◽  
Oral Surgical Procedures ◽  
Bleeding Rate ◽  
Risk Of Bleeding

IntroductionThe management of patients undergoing oral surgical procedures using anticoagulants raises concerns regarding the risk of bleeding. Bleeding rates in those patients during or after oral surgical procedures are uncertain. The aim of this study will be to determine the bleeding rate during and after oral surgeries in patients using anticoagulants.Methods and analysisA systematic review will be conducted and if appropriate, a meta-analysis of randomised clinical trials evaluating the bleeding risk during and after oral surgical procedures in patients using anticoagulants were selected. The literature search will be conducted using electronic databases, such as the Cochrane Central Register of Controlled Trials, MEDLINE (via Ovid), Embase (via Ovid), Cumulative Index to Nursing and Allied Health Literature (via Ovid), LILACS (SciELO) and CAPES database, without restriction of languages or date of publication. The primary outcome will be the occurrence of local bleeding rate during and after oral surgical procedures, and as secondary outcome, the following complications will be considered: implant failure, healing problems and infections. Groups of two independent reviewers will select the titles and abstracts for full-text eligibility. For eligible studies, the same reviewers will perform data extraction, bias risk assessment and determination of the overall quality of evidence for each of the outcomes using the Grading of Recommendations Assessment, Development and Evaluation classification system. Meta-analysis and subgroup analyses will be conducted, to all outcomes, if appropriate.Ethics and disseminationThe systematic review will be published in a peer-reviewed journal, and brief reports of the review’s findings will be released directly to the intended audience. The results will help dentists in the decision-making process to minimise the risk of bleeding in patients using anticoagulants in their clinical practice.PROSPERO registration numberCRD42017056986.

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
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