Experience in Use of Dabigatran at Knee Arthroplasty


Primary knee arthroplasty under combined spinal epidural anesthesia (CSEA) was performed to 30 patients with III stage of gonarthrosis. Anticoagulant prophylaxis of venous thromboembolism was started 12 hours prior to surgery - subcutaneous injections of 40 mg enoxaparine sodium (Clexane®). Postoperatively all patients were taken direct inhibitor of thrombin - dabigatran etexilate (Pradaxa®) by standard scheme: 110 mg in 3 hours after operation and than 220 mg once a day for 14 days. Deep vein thrombosis (DVT) was diagnosed in 2 cases (6.7% of patients). This rate was not higher than in case of prophylaxis with low molecular weight heparins. No hemorrhagic complications were noted. Maximum growth of total coagulation index was observed on 3 - 7 days after surgery that was manifested by raise of fibrinogen concentration, soluble fibrin-monomer complexes (SFMC) and increased activity of coagulation enzymic link. Indices returned to norm by 14th postoperative day. Use of dabigatran etexilate in knee arthroplasty provides an adequate prophylaxis of venous thromboembolism and does not increase the risk of hemorrhagic complications.


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