BACKGROUND: There has been some controversy about routine use of thromboprophylaxis after total knee arthroplasty (TKA) in Asian patients.
OBJECTIVE: To compare the efficacy and safety of enoxaparin in preventing venous thromboembolic diseases after TKA in Asian patients.
MATERIAL AND METHOD: We randomized 50 patients undergoing primary TKA into two equal groups, 25 patients received once daily subcutaneous enoxaparin injections as thromboprophylaxis and 25 control patients did not receive anticoagulation. The primary outcome was deep vein thrombosis (DVT) identified by color Doppler ultrasonography and/or pulmonary embolism (PE). All significant bleeding complications were recorded.
RESULTS: Deep vein thrombosis occurred in only one patient in the control group (4%) and in none in the enoxaparin group (0%, p = 0.31). No patient in both groups had clinical signs of PE. No patient had significant bleeding complications. One patient in enoxaparin group had a minor bleeding complication (4%) and also a surgical wound complication.
CONCLUSION: We concluded that the incidence of thromboembolic diseases after primary TKA in Thai patients is very low. Enoxaparin had no significant benefit in reducing venous thromboembolic complications after TKA in Asian patients, however it is safe in term of bleeding complications. We do not recommend routine use of enoxaparin as thromboprophylaxis after TKA in Asian patients.
This study aimed to compare the efficacy and safety of aspirin, rivaroxaban and low-molecular-weight heparin (LMWH) for post total knee arthroplasty (TKA) deep vein thrombosis (DVT) prophylaxis. Between July 2011 and July 2013, a prospective randomized controlled trial was performed on 324 patients with osteoarthritis who underwent primary unilateral TKA. Twelve hours after the surgery, Group A was given oral rivaroxaban at a dose of 10 mg/day. Group B was given subcutaneous LMWH at a dose of 4000 AxaIU (0.4 ml)/day and Group C was given oral aspirin at a dose of 100 mg/day. All three groups were treated for 14 days, and all of the patients were followed for 4 weeks. The incidence of DVT, dominant/hidden blood loss, the incidence of wound complications and the incidence of subcutaneous ecchymosis in the affected extremities were compared between the three groups. The incidence of DVT was lower in Group A compared with the other two groups [3 (2.94%) vs. 14 (12.50%), P = 0.029; 3 (2.94%) vs. 18 (16.36%), P = 0.017]. However, hidden blood loss [1.71 (1.19-2.97) vs. 1.18 (0.77-2.31), P = 0.009; 1.71 (1.19-2.97) vs. 1.30 (0.61-2.43), P = 0.004] and wound complications [5 (4.90) vs. 3 (2.67), P = 0.027; 5 (4.90) vs. 2 (1.82), P = 0.014] were more common in Group A than in the other groups. There were no significant differences between Group B and Group C in the incidence of DVT [14 (12.50%) vs. 18 (16.36%), P = 0.831], hidden blood loss [1.18 (0.77-2.31) vs. 1.30 (0.61-2.43), P = 0.327] or wound complications [3 (2.67) vs. 2 (1.82), P = 0.209]. No significant differences in the incidence of limb swelling were found between the three groups [38 (37.25%) vs. 28 (25.00%) vs. 24 (21.82%), P = 0.247]. Group A had a higher incidence of subcutaneous ecchymosis in the affected extremities than Group C [74 (72.55%) vs. 54 (49.09%), P = 0.039], but there were no significant differences between Groups A and B [74 (72.55%) vs. 62 (55.36%), P = 0.193] or between Groups B and C [62 (55.36%) vs. 54 (49.09%), P = 0.427]. Rivaroxaban has a positive anticoagulation effect but leads to increases in both postoperative blood loss and wound complications in patients. Hence, clinicians using rivaroxaban for anticoagulant therapy should closely monitor the changes in the hemoglobin level and wound healing and promptly supplement blood volume and provide other symptomatic and supportive treatments. No significant difference in post-TKA DVT prophylaxis was found between aspirin and LMWH, and the former can be used as part of a multimodal anticoagulation therapy.
PURPOSE: To compare the efficacy and safety of different modes of thromboembolic prophylaxis for elective total knee arthroplasty (TKA) in Asian patients. METHODS: 440 low-risk patients undergoing TKA were randomised into 4 equal groups: (1) no prophylaxis (control), (2) graduated compression stockings (GCS), (3) intermittent pneumatic compression (IPC), and (4) low-molecular-weight heparin (enoxaparin). Duplex ultrasonography was used as an assessment tool. RESULTS: The deep vein thrombosis point prevalence was highest in the control group (22%), which was significantly higher than in patients receiving IPC (8%, p=0.032) or enoxaparin (6%, p=0.001). One patient each in the control and GCS groups developed a non-fatal pulmonary embolism. Patients on enoxaparin received more blood transfusions and 2 of them had major bleeding complications. CONCLUSION: IPC is the preferred method of thromboprophylaxis for TKA in Asian patients.
Deux cent soixante-cinq patients subissant une arthroplastie totale du genou unilatérale ont été prospectivement randomisés pour recevoir une anesthésie rachidienne péridurale (SEA), un dispositif de compression VenaFlow veau, et de l'énoxaparine (groupe A) ou de l'EES, VenaFlow, et de l'aspirine (groupe B). L'aspirine a été commencé le jour de la chirurgie, alors que l'énoxaparine a été commencé 48 heures après la chirurgie. Les anticoagulants ont été poursuivi pendant 4 semaines après la chirurgie. Tous les patients avaient un test à l'hôpital échographie de dépistage sur les jours post-opératoires de 3 à 5 et un suivi de la deuxième échographie de 4 à 6 semaines après la chirurgie. Les généraux profondes taux de thrombose veineuse dans les groupes A et B étaient de 14,1% et 17,8% (P = non significatif), respectivement. Lorsqu'il est utilisé en combinaison avec des dispositifs de compression pneumatique et la mer, l'énoxaparine n'était pas supérieure à l'aspirine dans la prévention de la thrombose veineuse profonde après une arthroplastie totale du genou.
PURPOSE: To study the incidence of deep vein thrombosis in Indian patients undergoing total hip arthroplasty with or without prophylaxis, and the effect of enoxaparin on deep vein thrombosis.
METHODS: The study covered a total of 50 hips in 40 patients who underwent total hip arthroplasty. Patients were assessed for deep vein thrombosis using Doppler ultrasonography. The hips were numbered and divided into 2 groups: the odd-numbered hips did not receive any thrombo-prophylaxis, whereas the even-numbered hips received 40 mg of enoxaparin subcutaneously, once a day for 2 weeks, until the time of discharge.
RESULTS: Deep vein thrombosis was not found in both groups. We found wound haematomas in 9 patients (all of whom were on enoxaparin) (p<0.05), superficial infection in 2 patients (one on enoxaparin, one not), and local bruising in 4 patients (all of whom were on enoxaparin). Major haemorrhage did not occur in any of the cases.
CONCLUSION: The incidence of deep vein thrombosis in Indian patients is very low compared to that in European and American patients. Enoxaparin failed to provide any advantage to the patients. It is therefore not advisable to give prophylaxis/low-molecular-weight heparin for deep vein thrombosis to patients undergoing total hip arthroplasty without any risk factors.
CONTEXTE: Des essais antérieurs du traitement antiplaquettaire pour la prévention de la thromboembolie veineuse ont individuellement été concluantes, mais une méta-analyse de leurs résultats indiquent la réduction des risques de thrombose veineuse profonde et d'embolie pulmonaire dans différents groupes à haut risque. L'objectif de ce vaste essai randomisé contre placebo a été de confirmer ou de réfuter ces avantages apparents. MÉTHODES: En 1992-1998, 148 hôpitaux en Australie, en Nouvelle-Zélande, l'Afrique du Sud, la Suède et le Royaume-Uni randomisé 13.356 patients subissant une chirurgie pour fracture de la hanche, et 22 hôpitaux de la Nouvelle-Zélande un échantillonnage aléatoire 4088 autres patients qui subissent une arthroplastie élective. traitement à l'étude était de 160 mg d'aspirine par jour ou un placebo, a commencé avant l'opération et a continué pendant 35 jours. Les patients ont reçu une thromboprophylaxie autre jugé nécessaire. Le suivi a été de mortalité et de morbidité à l'hôpital jusqu'au jour 35. RÉSULTATS: Parmi les patients présentant une fracture de la hanche, l'attribution à l'aspirine produit des réductions proportionnelles dans l'embolie pulmonaire de 43% (95% IC 18-60, p = 0,002) et dans la thrombose veineuse profonde symptomatique de 29% (3-48, p = 0,03). embolie pulmonaire ou thrombose veineuse profonde a été confirmée dans 105 (1,6%) des 6679 patients affectés d'aspirine par rapport à 165 (2,5%) de 6677 attribué par placebo, ce qui représente une réduction absolue de 9 (SE 2) pour 1000 et une réduction proportionnelle des 36% (19 à 50, p = 0,0003). Des effets similaires ont été observés proportionnelle dans tous les principaux sous-groupes, y compris les patients recevant l'héparine sous-cutanée. L'aspirine empêche 4 (1) embolie pulmonaire fatale pour 1000 patients (18 vs groupe aspirine 43 décès groupe placebo), ce qui représente une réduction proportionnelle de 58% (27 à 76, p = 0,002), sans effet apparent sur les décès de toute une autre cause vasculaire (hazard ratio 1,04 [IC à 95% de 0,86 à 1,26]) ou provoquer la non-vasculaires (1,01 [0,84 à 1.23]). suite à une hémorragie décès ont été rares (13 vs 15 aspirine versus placebo), mais il y avait un excès de 6 (3) épisodes de saignement postopératoire transfusés pour 1000 patients affectés d'aspirine (p = 0,04). Parmi les patients électifs-arthroplastie, les taux de thrombose veineuse ont été plus faibles, mais les effets de l'aspirine proportionnelle étaient compatibles avec celles chez les patients avec fracture de la hanche. Interprétation: Ces résultats, ainsi que ceux de la méta-analyse précédente, montrent que l'aspirine réduit le risque d'embolie pulmonaire et de thrombose veineuse profonde par au moins un tiers pendant une période de risque accru. Par conséquent, il existe maintenant des preuves sérieuses de penser l'aspirine régulièrement dans un large éventail de groupes médicaux et chirurgicaux à haut risque de maladie thromboembolique veineuse.
150 Korean patients undergoing primary uncemented total hip replacement were randomized into 3 treatment groups for deep vein thrombosis (DVT) prophylaxis. Group A(50) were controls; Group B(50) received aspirin 1.2 g daily in 3 divided doses from 2 days before, to 14 days after surgery; Group C(50), received low molecular weight dextran 500 ml, infused intravenously at 50 ml/hour during surgery, and on each of the following 2 days. Contrast venograms were performed prior to surgery and 7-10 days after. The incidence of DVT was 20% in the control group, 12% in the aspirin group (p < 0.1 vs control), and 6% in the dextran group (p < 0.05 vs control). In patients developing DVT, the ratio of proximal to distal thrombi was increased in the control group as compared to treated groups (4:1 in the control group vs 1.5:1 in the treated groups). Both aspirin and dextran were well tolerated. Obesity (p < 0.05) and long-term administration of steroids (p < 0.05) were risk factors for deep vein thrombosis which reached statistical significance in the control group. Intraoperative venograms performed on 10 patients, showed that hip flexion (mean 40.4 degrees) plus adduction (mean 11.5 degrees) plus internal rotation (mean 81.5 degrees), resulted in severe twisting or kinking of the femoral vein with stagnation of blood flow. Low molecular weight dextran significantly reduce the incidence of deep venous thrombosis and aspirin, though less effective, had a similar effect.
There has been some controversy about routine use of thromboprophylaxis after total knee arthroplasty (TKA) in Asian patients.
OBJECTIVE:
To compare the efficacy and safety of enoxaparin in preventing venous thromboembolic diseases after TKA in Asian patients.
MATERIAL AND METHOD:
We randomized 50 patients undergoing primary TKA into two equal groups, 25 patients received once daily subcutaneous enoxaparin injections as thromboprophylaxis and 25 control patients did not receive anticoagulation. The primary outcome was deep vein thrombosis (DVT) identified by color Doppler ultrasonography and/or pulmonary embolism (PE). All significant bleeding complications were recorded.
RESULTS:
Deep vein thrombosis occurred in only one patient in the control group (4%) and in none in the enoxaparin group (0%, p = 0.31). No patient in both groups had clinical signs of PE. No patient had significant bleeding complications. One patient in enoxaparin group had a minor bleeding complication (4%) and also a surgical wound complication.
CONCLUSION:
We concluded that the incidence of thromboembolic diseases after primary TKA in Thai patients is very low. Enoxaparin had no significant benefit in reducing venous thromboembolic complications after TKA in Asian patients, however it is safe in term of bleeding complications. We do not recommend routine use of enoxaparin as thromboprophylaxis after TKA in Asian patients.
