| Inicio preoperatorio versus postoperatorio de tromboprofilaxis después de cirugía ortopédica mayor: seguridad y eficacia de la administración postoperatoria avalada por estudios recientes de nuevos anticoagulantes orales |
Preoperative versus postoperative initiation of thromboprophylaxis following major orthopedic surgery: safety and efficacy of postoperative administration supported by recent trials of new oral anticoagulants.
Perka C.
Orthopaedic Department, Charité, University Medicine Berlin, Free and Humboldt-University of Berlin, Berlin, Germany. carsten.perka@charite.de.
Thromb J. 2011 Nov 16;9:17.
Abstract
ABSTRACT: In European countries, low-molecular-weight heparin is generally initiated preoperatively for thromboprophylaxis in hip or knee replacement surgery. The objective of this review is to compare pre- and postoperative thromboprophylaxis strategies using available evidence, and discuss the challenges and issues that arise. Surgery is the first step in the process of thrombus formation, but thrombosis is not an instant process and the formation and growth of the thrombus can take several days or weeks. Hence, it may be possible to stop this process if thromboprophylaxis is initiated after surgery. Meta-analyses or systematic reviews comparing pre- and postoperative initiation of therapy have found no consistent differences in efficacy and similar safety (bleeding rates) between the two strategies. The recently available oral anticoagulant dabigatran etexilate provides thromboprophylaxis when administered postoperatively and is as safe as preoperative enoxaparin. Further support for the use of postoperative oral thromboprophylaxis in hip or knee replacement surgery has been provided by the phase III clinical trials of rivaroxaban and apixaban versus preoperative enoxaparin. Postoperative thromboprophylaxis offers the opportunity to change management practices in Europe. As postoperative initiation may have a clinical benefit in some settings (e.g. for neuraxial anesthesia) and practical advantages (e.g. allowing same-day admission), it is a worthwhile thromboprophylactic strategy for hip or knee replacement surgery.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228673/pdf/1477-9560-9-17.pdf
|
| La prueba para nuevos anticoagulantes orales: estudios de evidencia clínica |
The proof for new oral anticoagulants: clinical trial evidence.
Huisman MV.
Section of Vascular Medicine, Department of General Internal Medicine, Room CI R-43, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
Eur Orthop Traumatol. 2011 Jul;2(1-2):7-14. Epub 2011 May 19.
Abstract
INTRODUCTION:
Patients undergoing elective total hip or total knee replacement surgery are at increased risk of venous thromboembolism in the post-operative period and are recommended to receive thromboprophylaxis for 10-35 days. Although several thromboprophylactic agents are available, these are associated with well-recognized limitations. For the low molecular weight heparins (LMWHs) such as enoxaparin, these limitations include parenteral administration, indirect mode of action, inability to inhibit clot-bound thrombin and association with complications such as heparin-induced thrombocytopenia. These limitations make post-operative thromboprophylaxis challenging. Several new oral anticoagulants are in the advanced stages of clinical development. These agents have been designed to target either thrombin (dabigatran etexilate) or factor Xa (rivaroxaban and apixaban), which are key coagulation cascade enzymes. METHODS AND RESULTS: This review will present the published phase III clinical trial evidence of the efficacy and safety of dabigatran etexilate, rivaroxaban and apixaban, compared with the LMWH enoxaparin for the prevention of venous thromboembolism in patients who have undergone elective total hip or total knee replacement surgery. All three agents have shown comparable or superior efficacy compared with the European dose regimen of enoxaparin (40 mg once daily), and comparable rates of major bleeding events. Dabigatran etexilate and rivaroxaban are currently licensed for use following elective hip and knee replacement surgery in many countries, but no direct comparative data exist upon which to base the choice of agent. CONCLUSION: A thorough assessment of each individual patient's thromboembolic and bleeding risks should be the basis of selecting the agent in order to balance efficacy and safety
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150805/pdf/
12570_2011_Article_63.pdf
|
| Anticoagulantes potentes se asocian con mortalidad elevada de todas las causas después de artroplastia de cadera y rodilla |
Potent anticoagulants are associated with a higher all-cause mortality rate after hip and knee arthroplasty.
Sharrock NE, Gonzalez Della Valle A, Go G, Lyman S, Salvati EA.
Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. sharrockn@hss.edu
Clin Orthop Relat Res. 2008 Mar;466(3):714-21. Epub 2008 Feb 10.
Abstract
Anticoagulation for thromboprophylaxis after THA and TKA has not been confirmed to diminish all-cause mortality. We determined whether the incidence of all-cause mortality and pulmonary embolism in patients undergoing total joint arthroplasty differs with currently used thromboprophylaxis protocols. We reviewed articles published from 1998 to 2007 that included 6-week or 3-month incidence of all-cause mortality and symptomatic, nonfatal pulmonary embolism. Twenty studies included reported 15,839 patients receiving low-molecular-weight heparin, ximelagatran, fondaparinux, or rivaroxaban (Group A); 7193 receiving regional anesthesia, pneumatic compression, and aspirin (Group B); and 5006 receiving warfarin (Group C). All-cause mortality was higher in Group A than in Group B (0.41% versus 0.19%) and the incidence of clinical nonfatal pulmonary embolus was higher in Group A than in Group B (0.60% versus 0.35%). The incidences of all-cause mortality and nonfatal pulmonary embolism in Group C were similar to those in Group A (0.4 and 0.52, respectively). Clinical pulmonary embolus occurs despite the use of anticoagulants. Group A anticoagulants were associated with the highest all-cause mortality of the three modalities studied.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505231/
pdf/11999_2007_Article_92.pdf
|
| Heparina de bajo peso molecular en la profilaxis de trombosis venosa profunda en pacientes quirúrgicos asiáticos. Experiencia en Kashmir |
Low molecular weight heparin in prophylaxis of deep vein thrombosis in Asian general surgical patients: A Kashmir experience.
Dar TI, Wani KA, Ashraf M, Malik A, Ahmad S, Gojwari TA, Iqbal A.
Indian J Crit Care Med [serial online] 2012 [cited 2012 Jul 28];16:71-4.
Background and Objectives: Deep vein thrombosis (DVT) occurs at a lower rate in Asia than in the rest of the world. We wanted to study the significance and efficacy of low molecular weight heparin (LMWH) in prophylaxis of DVT in major general surgical patients in the Kashmir Valley (India, Asia) so as to make it a routine in our patients. Patients and Methods: This was a prospective study in which the effect of LMWH was compared with no prophylaxis. Results: LMWHs are more effective than no prophylaxis in the prevention of DVT and pulmonary thromboembolism in highest-risk general surgical patients (odds ratio = 16.64; 95% confidence interval = 3.63-1130.03; P-value = 0.014). Conclusion: LMWHs have a significant prophylactic effect on DVT in general surgical patients, with a higher benefit to risk ratio, and, in spite of the low incidence of DVT in Asia, its prophylaxis should routinely be considered in this part of the world as well, preferably in the form of LMWHs.
http://www.ijccm.org/text.asp?2012/16/2/71/99107
|
|
No hay comentarios:
Publicar un comentario