fondaparinux and Osteoarthritis--Knee

Fondaparinux has been shown to be as effective as low molecular weight heparin\ in orthopedic surgery, with no cases of heparin induced thrombocytopenia proven until today. The\ main goal of this prospective randomized controlled trial was to define whether thromboprophylaxis\ in patients with primary osteoarthritis of the knee undergoing total knee arthroplasty (TKA) influences\ clinical parameters in the same manner in patients receiving fondaparinux as in those receiving\ nadroparin during the first 7 postoperative days. Sixty patients with primary knee osteoarthritis underwent\ unilateral TKA performed by the same surgeon and were randomized into two groups of 30\ patients receiving either fondaparinux or nadroparin thromboprophylaxis. Patients were compared\ according to the duration of operation, perioperative blood loss, laboratory results and clinical evaluation\ of the edema during the early postoperative period. No differences were found between the\ groups in the mean duration of surgery, perioperative blood loss, and most of laboratory results. The\ level of urea was significantly lower in the nadroparin group on the first and second postoperative day.\ No cases of heparin induced thrombocytopenia, deep vein thrombosis or pulmonary embolism were\ noted during the study. Study results showed both fondaparinux and nadroparin to have the same\ influence on clinical parameters during the first 7 postoperative days in patients undergoing TKA.

Topics: Adult; Anticoagulants; Arthroplasty, Replacement, Knee; Factor Xa Inhibitors; Female; Fondaparinux; Humans; Male; Middle Aged; Nadroparin; Osteoarthritis, Knee; Polysaccharides; Postoperative Complications; Prospective Studies; Venous Thromboembolism

The objective of this prospective randomized controlled trial was to assess the efficacy and safety of simultaneous application of tranexamic acid and indirect factor Xa inhibitor following total knee arthroplasty (TKA).. Seventy-two primary osteoarthritis patients undergoing unilateral TKA using fondaparinux as a basic thromboprophylaxis were randomized to receive either placebo (36 patients) or tranexamic acid (36 patients). Prophylaxis against venous thromboembolism in all patients was administered with subcutaneous doses of 2.5 mg fondaparinux for 5 days post-operatively. Post-operative retransfusion volume, allogenic transfusion volumes and drain amount were recorded for each patient. Level of haemoglobin, prothrombin time, activated partial thromboplastin time and D-dimer were also assessed. Doppler ultrasonography was performed preoperatively and 7 days after surgery.. The rate of transfusion was lower in the tranexamic acid group than in the placebo group (p = 0.007). The drained blood volume during the initial 24 h and until drain removal was smaller in the tranexamic acid group than in the placebo group (p < 0.001). However, the haematologic laboratory results did not show any significant differences between the two groups. The prevalence of deep-vein thrombosis (DVT) was 4 (11.1 %) in the placebo group and 3 (8.3 %) in the tranexamic acid group (p = n.s.). There was no proximal DVT and no symptomatic pulmonary embolism in either group.. The use of tranexamic acid could reduce acute blood loss significantly without any adverse effect resulted from drug interaction with concomitant use of indirect factor Xa inhibitor following TKA. Therefore, simple combination of these drugs can be recommended to reduce post-operative blood loss as well as to reduce DVT following TKA.

Topics: Aged; Anticoagulants; Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Factor Xa Inhibitors; Female; Fondaparinux; Humans; Male; Middle Aged; Osteoarthritis, Knee; Polysaccharides; Postoperative Hemorrhage; Prospective Studies; Tranexamic Acid; Venous Thromboembolism

Patients undergoing total knee arthroplasty (TKA) are at high risk of venous thromboembolism, manifesting as deep vein thrombosis (DVT) or pulmonary embolism. The purpose of this study is to evaluate the efficacy and safety of edoxaban 15 mg once daily (o.d.) for preventing DVT in patients undergoing TKA.. Three hundred patients undergoing primary TKA under general anaesthesia for osteoarthritis were enrolled in this study: 100 treated with enoxaparin 2,000 IU twice daily (b.i.d.), 100 treated with fondaparinux 1.5 mg o.d. and 100 treated with edoxaban 15 mg o.d.. All treatments were scheduled to continue for 14 days.. The incidence of DVT in patients treated with edoxaban 15 mg o.d. was lower than in patients with enoxaparin 2,000 IU b.i.d. and fondaparinux 1.5 mg o.d.. D-dimer levels were significantly lower in patients with edoxaban than in patients with enoxaparin and fondaparinux 1.5 mg o.d. on the first postoperative day; ΔHb levels were lower in patients with edoxaban than in patients with enoxaparin and fondaparinux on postoperative days, However, the difference was not statistically significant. Finally, the incidence of hepatic dysfunction was lower in patients with edoxaban than in patients with enoxaparin and fondaparinux.. Edoxaban 15 mg o.d. was more efficient than enoxaparin 2,000 IU b.i.d. and fondaparinux 1.5 mg o.d.. Furthermore, edoxaban was safe compared with enoxaparin and fondaparinux. Edoxaban, an orally administered direct factor Xa (FXa) inhibitor, may offer a new option for preventing DVT, with a level of evidence III.

Topics: Aged; Anticoagulants; Arthroplasty, Replacement, Knee; Dose-Response Relationship, Drug; Enoxaparin; Female; Fondaparinux; Humans; Incidence; Knee Joint; Male; Osteoarthritis, Knee; Polysaccharides; Pyridines; Retrospective Studies; Thiazoles; Treatment Outcome; Venous Thromboembolism; Venous Thrombosis

Clinical evidence demonstrating the effectiveness of pharmacological and mechanical thromboprophylaxis for the prevention of pulmonary embolism is limited because the prevalence of postoperative pulmonary embolism following total hip and knee arthroplasty is very low. Our purposes were to characterize a patient population with in-hospital pulmonary embolism, to identify perioperative risk factors associated with pulmonary embolism, and to analyze the effect of combining fondaparinux with mechanical prophylaxis on the prevalence of pulmonary embolism following total hip and knee arthroplasty.. We retrospectively identified 27,542 patients who underwent total hip or knee arthroplasty at 793 hospitals, using data from the Diagnosis Procedure Combination database, collected from July 1 to December 31 in 2007 and 2008. We extracted data on patient sex, age, primary diagnoses, and comorbidities that could potentially affect the prevalence of pulmonary embolism. The dates of pharmacological and mechanical thromboprophylaxis were identified for each patient. Logistic regression analysis was performed to analyze the concurrent effects of various factors on the prevalence of postoperative pulmonary embolism.. The mean age (and standard deviation) of the patients at the time of arthroplasty was 69.9 ± 10.3 years, and 23,783 patients (86.4%) were diagnosed as having osteoarthritis. The overall mean duration of anesthesia was 159 ± 84 minutes. The overall prevalence of postoperative pulmonary embolism was 0.55% (151 of 27,542). Significant risk factors for postoperative pulmonary embolism included age, number of comorbidities, diagnosis of rheumatoid arthritis, type of anesthesia, and duration of anesthesia. Multivariate analysis found that the prevalence of postoperative pulmonary embolism was significantly reduced when fondaparinux was used in combination with mechanical prophylaxis, compared with the use of mechanical prophylaxis alone (0.40% versus 0.66%; odds ratio, 0.60; 95% confidence interval, 0.42 to 0.84; p = 0.003).. These findings could help to identify patients at higher risk of postoperative pulmonary embolism after total hip or knee arthroplasty. Our results demonstrate the effectiveness of fondaparinux in combination with mechanical prophylaxis for the prevention of postoperative pulmonary embolism after total hip or knee arthroplasty.

Topics: Aged; Anticoagulants; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Cohort Studies; Confidence Intervals; Databases, Factual; Female; Follow-Up Studies; Fondaparinux; Humans; Incidence; Intermittent Pneumatic Compression Devices; Japan; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Osteoarthritis, Hip; Osteoarthritis, Knee; Polysaccharides; Postoperative Care; Postoperative Complications; Pulmonary Embolism; Retrospective Studies; Risk Assessment; Stockings, Compression; Treatment Outcome

Topics: Anticoagulants; Arthroplasty, Replacement; Clinical Trials as Topic; Fondaparinux; Humans; Orthopedic Procedures; Osteoarthritis, Hip; Osteoarthritis, Knee; Polysaccharides; Postoperative Complications; Research Design; Thromboembolism; Treatment Outcome; Venous Thrombosis

Total knee arthroplasty (TKA) has been in development since the early 1970s. Insall and others established the principles of ligament balance and overall alignment for implant success. Repicci introduced the concept of minimally invasive surgery in the early 1990s using the unicondylar prosthesis. As the outcomes of minimally invasive surgeries continued to improve when using a unicondylar prosthesis, it was logical to attempt a minimally invasive TKA. The author and his team have performed 120 minimally invasive TKAs over the past 2 years. Early results show that a minimally invasive approach produces better early motion, less blood loss, less pain, and a shorter hospital stay than the standard TKA with no compromise in accuracy.

Topics: Aged; Aged, 80 and over; Anticoagulants; Arthroplasty, Replacement, Knee; Cohort Studies; Female; Follow-Up Studies; Fondaparinux; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Osteoarthritis, Knee; Polysaccharides; Postoperative Care; Postoperative Complications; Recovery of Function; Retrospective Studies; Risk Assessment; Severity of Illness Index; Treatment Outcome; Venous Thrombosis