Efficacy and Safety of New Oral Anticoagulants in the Prevention of Venous Thromboembolism after Orthopaedic Surgery


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Abstract

Relevance. Despite of a specific prophylaxis, the thromboembolic complications occur in 20-25% of patients after orthopedic surgeries. In those who do not receive the prophylaxis the complications rate is even higher taking up to 45-70% thereby putting the complications into second place after infection complications.

Objective. To compare the efficacy and safety of dabigatran etaxilate and rivaroxaban in prophylaxis and treatment of the venous thromboembolism after hip and knee arthroplasty.

Materials and methods. An analysis of prophylaxis and treatment of venous thromboembolism in 104 patients who had had hip and knee arthroplasty has been accomplished. All patients were randomized into two groups. 51 patients were enrolled into the first (control) group where 220 mg per day dabigatran etexilat therapy was used. The second (investigated) group included 53 patients who received 10 mg per day rivaroxabane therapy. A year after surgery the quality of life of patients was assessed using CIVIQ-20 and SF-36 questioners.

Results and their discussion. Venous thromboembolic complications had occurred in 18 (17,3%) of patients equally in the first and second group. Isolated common femoral vein thrombosis was found in 8 (7,7%), and in 3 (2,9%) patients it was associated with pulmonary embolism. Popliteal and tibial vein thrombosis was detected in 7 (6,7%) patients. Internal bleeding complications were found in 9 (8,6%) patients with venous thrombosis. The complications were more common in a second group (higher by 1,7%). In 7 (6,7%) cases the complications had no clinical significance. Only in 2 (1,9%) patients (one case in each group) were documented severe hemorrhages, that needed hemostatic therapy. A year after surgery the quality of life of patients was assessed using specifically oriented CIVIQ-20 and SF-36 international questioners for chronic venous insufficiency. The evidence based differences between two groups were not discovered.

Conclusion. Dabigatran etexilate as well as rivaroxaban can be used for prophylaxis of the venous thromboembolism after orthopedic surgeries.

About the authors

Boris Semenovich Sukovatykh

Kursk State Medical University

Author for correspondence.
Email: SukovatykhBS@kursksmu.net
ORCID iD: 0000-0003-2197-8756

MD, Prof., the head of the department of General Surgery

Russian Federation, 3 K.Marx str., Kursk, 305041, Russian Federation

Mikhail Borisovich Sukovatykh

Kursk State Medical University

Email: SukovatykhMB@kursksmu.net
ORCID iD: 0000-0002-8230-5283

PhD., the associate professor of the department of General Surgery

Russian Federation, 3 K.Marx str., Kursk, 305041, Russian Federation

Sergey Olegovich Perkov

Kursk State Medical University

Email: Perkovso@yandex.ru
ORCID iD: 0000-0003-4031-2239

6th year studying student

Russian Federation, 3 K.Marx str., Kursk, 305041, Russian Federation

References

  1. Kopenkin, S.S. Profilaktika venoznykh tromboembolicheskikh oslozhnenii v ortopedicheskoi khirurgii: novye vozmozhnosti [Prevention of Venous Thromboembolic Complications in Orthopaedic Surgery: New Possibilities] Vestnik travmatologii ortopedii iim. N.N. Priorova. 2010; 1: 35–38. (in Russ.)
  2. Kulinchik T.V., Rebrova O.Iu., Margieva A.V. Klinicheskaia effektivnost' i bezopasnost' pervichnoi profilaktiki tromboticheskikh oslozhnenii posle ortopedicheskikh operatsii [Clinical Efficacy and Safety of Primary Thrombotic Complications Prevention after Orthopaedic Operations] Vestnik travmatologii i ortopedii im. N.N. Priorova. 2012; 3: 39–46. (in Russ.)
  3. Pasechnik I.N. Ispol'zovanie novykh oral'nykh antikoaguliantov v khirurgii [The use of new oral anticoagulants in surgery] Khirurgiya im N.I. Pirogova. 2016; 2: 72-75. (in Russ.)
  4. Firsov S.A., Levshin A.G., Matveev R.P. Rossiiskii opyt ratsional'noi tromboprofilaktiki v travmatologii i ortopedii [Russian Experience in Rational Thromboprophylaxis in Traumatology and Orthopaedics] Vestnik travmatologii i ortopedii im. N.N. Priorova. 2015; 2: 36–42.(in Russ.)
  5. Gomez-Outes A. Dabigatran, rivaroxaban, or apixaban versus
  6. enoxaparin for thromboprophylaxis after total hip or knee replacement: systematic review, meta-analysis, and indirect treatment comparisons. BMJ. 2012; 344: 36-75.
  7. Huisman M.V., Quinlan D.J., Dahl O.E., Schulman S. Enoxaparin
  8. versus dabigatran or rivaroxaban for thromboprophylaxis after hip
  9. or knee arthroplasty: results of separate pooled analyses of Phase III multicenter randomized trials. Circ Cardiovasc Qual Outcomes.- 2010; 3: 6: 652–660.
  10. Lieberman J.R., Pensak M.J. Prevention of venous thromboembolic disease after total hip and knee arthroplasty. J Bone Joint Surg Am. 2013; 95: 19: 1801–1811.
  11. Loke Y.K., Kwok C.S. Dabigatran and rivaroxaban for prevention of venous thromboembolism – systematic review and adjusted indirect comparison. Journal of Clinical Pharmacy and Therapeutics. 2011; 36:111–124.

Copyright (c) 2017 Sukovatykh B.S., Sukovatykh M.B., Perkov S.O.

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