Optimization of Approaches to the Prevention of Thromboembolic Complications after Total Hip Arthroplasty

Abstract


To choose the optimum scheme of anticoagulant therapy for the prevention of thromboembolic complications after total hip arthroplasty 86 patients were examined. The patients were randomly divided into 3 groups. In group 1 (n=29) prevention of thromboembolic complications was performed by subcutaneous injection of enoxaparin (40 mg) started 12 hours before the surgery. In group 2 (n=28) enoxaparin (40 mg) was started 12 hours after surgical intervention. In those groups thromboprophylaxis with enoxaparin was continued during hospitalization period and at discharge the patients were given recommendations to take dabigatran etexilate up to 35 days. In group 3 (n=29) patients received oral dabigatran etexilate, 110 mg 1 - 4 hours after surgery, followed by 220 mg once-daily both at hospital and out-patient stage of treatment. The average duration of hospitalization made up 8.9±1.2 days. Minimum fibrinogen and D-dimer levels as well as maximum APTT values were observed in patients from group 3 on the 5th postoperative day. Thromboelastogram showed that on day 5 both plasma and platelet hypocoagulation were most expressed in 3rd group. Preoperative thrombodynamics showed high rate of clot growth and high percentage of spontaneous clots formation in all three groups that assumed initial hypercoagulation with maximum decrease of the frequency of spontaneous clots formation against the background of dabigatran prophylaxis. The lowest number (3,4%) of thromboembolic complications, i.e. distal thromboses, were observed in patients from dabigatran etexilate group. Assessment of anticoagulant prophylaxis costs showed a clear advantage of the 3rd group.

Full Text

Restricted Access

About the authors

L. V Borisova

Federal Centre of Traumatology, Orthopedics and Endoprosthesis

Email: lborisova@orthoscheb.com
Cheboksary, Russia

N. S Nikolaev

Federal Centre of Traumatology, Orthopedics and Endoprosthesis

Cheboksary, Russia

N. Yu Dobrovol’skaya

Federal Centre of Traumatology, Orthopedics and Endoprosthesis

Cheboksary, Russia

T. A Vuimo

Dmitry Rogachev Federal Research and Clinical Center of Pediatric Hematology, Oncology and Immunology

Moscow, Russia

A. V Orlova

Federal Centre of Traumatology, Orthopedics and Endoprosthesis

Cheboksary, Russia

Z. A Kachaeva

Federal Centre of Traumatology, Orthopedics and Endoprosthesis

Cheboksary, Russia

S. N Didichenko

Federal Centre of Traumatology, Orthopedics and Endoprosthesis

Cheboksary, Russia

References

  1. Ceerts W.H., Pineo G.F., Heit J.A., Bergqvist D., Lassen M.R., Colwell C.W., Ray J.G. Prevention of venous thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004; 126 (3 Suppl): 338S-400S.
  2. White R.H., Romano P.S., Zhou H., Rodrigo J., Bargar W. Incidence and time course of thromboembolic outcomes following total hip or knee arthroplasty. Arch. Intern. Med. 1998; 158 (14): 1525-31.
  3. Тлеубаева Н.В. Патогенетические аспекты послеоперационных тромботических осложнений при деформирующем остеоартрозе: Автореф. дис. … канд. мед. наук. Кемерово; 2009.
  4. Geerts W.H., Bergqvist D., Pineo G.F., Heit J.A., Samama C.M., Lassen M.R., Colwell C.W.; American College of Chest Physicians. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th ed.). Chest. 2008; 133 (6 Suppl): 381S-453S.
  5. Goldhaber S., Tapson V.F. DVT Free Steering Committee. A Prospective Registry of 5, 451 patients with ultrasound-confirmed deep vein thrombosis. Amer. J. Card. 2004; 93 (2): 259-62.
  6. Hirsh J. Guidelines for antithrombotic therapy. Fifth ed. BC Decker inc; 2005.
  7. Профилактика венозных тромбоэмболических осложнений в травматологии и ортопедии. Российские клинические рекомендации. Травматология и ортопедия России. 2012; 1 (63): 1-24.
  8. Копенкин С.С. Профилактика венозных тромбоэмболических осложнений в ортопедической хирургии: новые возможности. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2010; 1: 35-8.
  9. Омельяновский И.И., Загородний Н.В., Маргиева А.В., Цфасман Ф.М. Клинико-экономический анализ эффективности и безопасности методов профилактики тромбоэмболических осложнений при ортопедических вмешательствах. Хирургия. Журнал им. Н.И. Пирогова. 2010; 5: 72-81.
  10. Eriksson B., Dahl O., Rosencher N., Kurth A.A., vanDijk C.N., Frostick S.P. et al.; RE-MODEL Study Group. Oral dabigatran etexilate versus subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J. Tromb. Haemost. 2007; 5 (11): 2178-85.
  11. Eriksson B., Dahl O., Rosencher N., Kurth A.A., vanDijk C.N., Frostick S.P. et al.; RE-NOVATE StudyGroup. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomized, double-blind, nоn-inferiority trial. Lancet. 2007; 370 (9591): 949-56.
  12. Момот А.П., Меркулов И.В., Григорьева Е.В., Панов М.Ю. Тромбопрофилактика эноксапарином и дабигатраном после эндопротезирования тазобедренного сустава. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2011; 2: 67-70.
  13. Шаталова О.В., Смусева О.Н., Горбатенко В.С., Маслаков А.С. Экономическая эффективность применения новых пероральных антикоагулянтов при венозном тромбозе. Вестник ВолгГМУ. 2014; 4 (52): 70-3.
  14. Затейщиков Д.А., Зотова И.В. Дабигатран: перспективы клинического применения. Фарматека. 2011; 15: 30-4.
  15. Стуров Н.В., Моисеев С.В. Клиническая фармакология дабигатрана - представителя нового класса антикоагулянтов - прямых ингибиторов тромбина. Клиническая фармакология и терапия. 2009; 5: 32-7.

Statistics

Views

Abstract - 32

Cited-By


Article Metrics

Metrics Loading ...

Refbacks

  • There are currently no refbacks.

Copyright (c) 2016 Eco-Vector



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies