DO WE KNOW ALL ABOUT PREVENTION OF VENOUS THROMBOEMBOLISM AFTER MAJOR ORTHOPEDIC SURGERY?

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Abstract

Venous thromboembolic events including deep venous thrombosis of lower limbs, tromboembolia of the pulmonary artery as well as non-symptomatic venous thromboembolic events are identified via venography and are considered to be potentially life-threatening implications after such major surgeries as total hip and knee arthroplasty. The need for tromboprophylaxis is well realized at present, and there is a wide range of medications with the indication of post-surgical prophylaxis of venous thromboembolic events.

In this report the attempt has been made to carry out the comparative analysis of various currently used functional national guidelines on prophylaxis of venous thromboembolic events after total hip and knee arthroplasty. Moreover, having done the research in the systems PubMed (http://www.ncbi.nlm.nih.gov/pubmed, 2007–2017 гг.) and eLIBRARY (http://elibrary.ru, 2007–2017 гг.) the data of the last 10 years of experience in administration of oral anticoagulants has been collected and thoroughly analyzed (dabigatran etexilat, rivaroxaban, apixaban) and antiaggregant (acetylsalicylic acid) in clinical practice, besides comparative data has been also collected based on results obtained from laboratory control of anticoagulative effect of thrombin and x-factor direct inhibitors, even though the opportunities that laboratory control can provide are so far highly limited.

At present the efficacy of pharmacological prophylaxis of venous thromboembolic events after total hip and knee arthroplasty is absolutely proven, and the issues concerning the safety of anticoagulants administration are the main focus. These issues frequently require personalized approach to selection of medication for tromboprophylaxis in accordance with the patient’s characteristics and the type of surgery chosen. All these aspects should become the focus for further research.

About the authors

S. A. Bozhkova

Vreden Russian Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: clinpharm-rniito@yandex.ru

Dr. Sci. (Med.), Head of the Research Department of Prevention and Treatment of Wound Infection and Department of Clinical Pharmacology

8, ul. Akad. Baykova, 195427, St. Petersburg

Россия

A. R. Kasimova

Vreden Russian Research Institute of Traumatology and Orthopedics;
Pavlov First Saint Petersburg State

Email: fake@neicon.ru

Clinical Pharmacologist, Department of Clinical Pharmacology

Assistant, Department of Clinical Pharmacology and Evidence-Based Medicine

8, ul. Akad. Baykova, 195427, St. Petersburg

6-8, ul. L’va Tolstogo, 197022, St. Petersburg

Россия

V. B. Nakopia

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Researcher, Scientific Department of Diagnosis and Treatment of Musculoskeletal System Diseases and Injuries

8, ul. Akad. Baykova, 195427, St. Petersburg

Россия

N. N. Kornilov

Vreden Russian Research Institute of Traumatology and Orthopedics;
Mechnikov North-Western State Medical University

Email: fake@neicon.ru

Dr. Sci. (Med) Professor of Traumatology and Orthopaedics Chair

Associate Professor, Department of Traumatology and Orthopaedics 

8, ul. Akad. Baykova, 195427, St. Petersburg

41, Kirochnaya ul., 191015, St. Petersburg

Россия

References

  1. Falck-Ytter Y., Francis C.W., Johanson N.A., Curley C., Dahl O.E., Schulman S. et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl):e278S-e325S. doi: 10.1378/chest.11-2404.
  2. Geerts W.H., Bergqvist D., Pineo G.F., Heit J.A., Samama C.M., Lassen M.R., Colwell C.W. American college of chest physicians. Prevention of venous thromboembolism: american college of chest physicians evidence-based clinical practice guidelines (8th Edition). Chest. 2008;133(6 Suppl):381S-453S. doi: 10.1378/chest.08-0656.
  3. Prevention of venous thrombosis and pulmonary embolism. National Institutes of Health Consensus Conference. JAMA. 1986;256(6):744-749.
  4. Kurtz S., Ong E., Mowat F., Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780-785.
  5. Шубняков И.И., Тихилов Р.М., Николаев Н.С., Григоричева Л.Г., Овсянкин А.В., Черный А.Ж., Дроздова П.В., Денисов А.О., Вебер Е.В., Кузьмина И.В. Эпидемиология первичного эндопротезирования тазобедренного сустава на основании данных регистра артропластики РНИИТО им. Р.Р. Вредена. Травматология и ортопедия России. 2017;23(2):81-101. doi: 10.21823/2311-2905-2017-23-2-81-101. Shubnyakov I.I., Tikhilov R.M., Nikolaev N.S., Grigoricheva L.G., Ovsyankin A.V., Cherny A.Z., Drozdova P.V., Denisov A.O., Veber Е.V., Kuz’mina I.V. [Epidemiology of primary hip arthroplasty: report from register of vreden Russian Research Institute of traumatology and orthopedics]. Travmatologiya i ortopediya Rossii [Traumatology and orthopedics of russia]. 2017;23(2):81-101. (in Russian). doi: 10.21823/2311-2905-2017-23-2-81-101.
  6. Божкова С.А. Особенности выбора антикоагулянтов для профилактики венозных тромбозов и эмболий после крупных ортопедических операций: взгляд клинического фармаколога. Травматология и ортопедия России. 2011;(1):138-143. Bozhkova S.A. [Specificity of anticoagulant choice for VTE prophylaxes after major orthopedic surgery – the view of clinical pharmacologists. Travmatologiya i ortopediya Rossii [Traumatology and orthopedics of russia]. 2011;(1):138-143. (in Russian).
  7. Божкова С.А., Новокшонова А.А., Дроздова П.В. Аспекты практического применения прямых оральных антикоагулянтов в стационаре травматологоортопедического профиля. Хирургия. Журнал им. Н.И. Пирогова. 2014;(11):48-54. Bozhkova S.A., Novokshonova A.A., Drozdova P.V. [Aspects of practical application of direct oral anticoagulants in the hospital of traumatologortopedic profile]. Khirurgiya. Zhurnal im. N.I. Pirogova [Journal Surgery named after N.I. Pirogov]. 2014;(11):48-54. (in Russian).
  8. Российские клинические рекомендации «Профилактика венозных тромбоэмболических осложнений в травматологии и ортопедии». Травматология и ортопедия России. 2012;1(приложение):2-24. [Russian clinical guidelines «Prevention of venous thromboembolic complications in traumatology and orthopedics»]. Travmatologiya i ortopediya Rossii [Traumatology and orthopedics of russia]. 2012;1(suppl):2-24. (in Russian).
  9. Российские клинические рекомендации по диагностике, лечению и профилактике ВТЭО. Флебология. 2015;9(4, вып. 2):2-52. [Russian clinical guidelines for diagnosis, treatment and prevention vte]. Flebologiya [Journal of Venous Disorders]. 2015; 9(4, issue 2):2-52. (in Russian).
  10. AAOS – American Academy of Orthopaedic Surgeons clinical guideline on prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty. Available at: http://www.aaos.org/ research/guidelines/VTE/VTE_full_guideline.pdf+
  11. Hill J., Treasure T. Guideline Development Group. Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital: summary of the NICE guideline. Heart. 2010;96(11):879-882. doi: 10.1136/hrt.2010.198275.
  12. Scotish Intercollegiate Guidelines Network (2010) Prevention and management of venous thromboembolism. Available at: http://www.sign. ac.uk/ guidelines/fulltext/122/index.html.
  13. Papadopoulos D.V., Kostas-Agnantis I., Gkiatas I., Tsantes A.G., Ziara P., Korompilias A.V. The role of new oral anticoagulants in orthopaedics: an update of recent evidence. Eur J Orthop Surg Traumatol. 2017;27(5):573- 582. doi: 10.1007/s00590-017-1940-x.
  14. Junqueira D.R., Zorzela L.M., Perini E. Unfractionated heparin versus low molecular weight heparins for avoiding heparin-induced thrombocytopenia in postoperative patients. Cochrane Database Syst Rev. 2017;4:CD007557. doi: 10.1002/14651858.CD007557.pub3.
  15. Гендлин Г.Е., Борисов С.Н. Идеальный антикоагулянт? Атмосфера. Новости кардиологии. 2010;(2-3):2-6. Gendlin G.E., Borisov S.N. [The ideal anticoagulant?] Atmosfera. Novosti kardiologii [Atmosphere. Cardiology news]. 2010;(2-3):2-6. (in Russian).
  16. Mouly S., Lloret-Linares C., Sellier P.O., Sene D., Bergmann J.F. Is the clinical relevance of drug-food and drug-herb interactions limited to grapefruit juice and Saint-John’s Wort? Pharmacol Res. 2017;118:82-92. doi: 10.1016/j.phrs.2016.09.038.
  17. Stangier J. Clinical pharmacokinetics and pharmacodynamics of the oral direct thrombin inhibitor dabigatran etexilate. Clin Pharmacokinet. 2008;47(5):285-295. doi: 10.2165/00003088-200847050-00001.
  18. Kvasnicka T., Malikova I., Zenahlikova Z., Kettnerova K., Brzezkova R., Zima T., Ulrych J., Briza J., Netuka I., Kvasnicka J. Rivaroxaban – metabolism, pharmacologic properties and drug interactions. Curr Drug Metab. 2017;18(7):636-642. doi: 10.2174/1389200218666170518165443.
  19. National Health and Medical Research Council (NHMRC) (2009) Prevention of venous thromboembolism in patients in Patients Admitted to Australian Hopsitals. Available at: https://www.nhmrc.gov.au/ guidelinespublications/cp115.
  20. Kendoff D., Perka C., Fritsche H.M., Gehrke T., Hube R. Oral thromboprophylaxis following total hip or knee replacement: review and multicentre experience with dabigatran etexilate. Open Orthop J. 2011;5:395-399. doi: 10.2174/1874325001105010395.
  21. Bloch B., Patel V., Best A. Thromboprophylaxis with dabigatran leads to an increased incidence of wound leakage and an increased length of stay after total joint replacement. Bone Joint J. 2014;96-B(1):122-126. doi: 10.1302/0301-620X.96B1.31569.
  22. Rosencher N., Samama C., Feuring M., Brueckmann M., Kleine E., Clemens A., Frostick S. Dabigatran etexilate for thromboprophylaxis in over 5000 hip or knee replacement patients in a real-world clinical setting. Thromb J. 2016;14:8. doi: 10.1186/s12959-016-0082-4.
  23. Gill S.K., Theodorides A., Smith N., Maguire E., Whitehouse S.L., Rigby M.C., Ivory J.P. Wound problems following hip arthroplasty before and after the introduction of a direct thrombin inhibitor for thromboprophylaxis. Hip Int. 2011;21(6):678-683. doi: 10.5301/HIP.2011.8842.
  24. Mommsen P., Doering M., Egidy C., Gehrke T., Krettek C., Kendoff D. Effects of thromboembolism prophylaxis with dabigatran on perioperative blood loss and wound secretion in primary hip arthroplasty. Technol Health Care. 2014;22(6):901-908. doi: 10.3233/THC-140859.
  25. Рыбников А.В., Бялик Е.И., Решетняк Т.М., Макаров С.А., Макаров М.А., Павлов В.П., Храмов А.Э. Эффективность профилактики венозных тромбоэмболических осложнений при эндопротезировании крупных суставов у больных с ревматоидным артритом и остеоартрозом (проспективное исследование) Политравма. 2016;(2):48-54. Rybnikov A.V., Byalik E.I., Reshetnyak T.M., Makarov S.A., Makarov M.A., Pavlov V.P., Khramov A.E. [Efficiency of prevention of venous thromboembolic complications in endoprosthetics of large joints in patients with rheumatoid arthritis and osteoarthrosis (a prospective study)]. Politravma [Polytrauma]. 2016;(2):48-54. (in Russian).
  26. Turpie A.G., Haas S., Kreutz R., Mantovani L.G., Pattanayak C.W., Holberg G., Jamal W., Schmidt A., van Eickels M., Lassen M.R. A non-interventional comparison of rivaroxaban with standard of care for thromboprophylaxis after major orthopaedic surgery in 17,701 patients with propensity score adjustment. Thromb Haemost. 2014;111(1):94-102. doi: 10.1160/TH13-08-0666.
  27. Beyer-Westendorf J., Lützner J., Donath L., Tittl L., Knoth H., Radke O.C., Kuhlisch E., Stange T., Hartmann A., Günther K.P., Weiss N., Werth S. Efficacy and safety of thromboprophylaxis with low-molecularweight heparin or rivaroxaban in hip and knee replacement surgery. Thromb Haemost. 2013;109(1): 154-163. doi: 10.1160/TH12-07-0510.
  28. Загородний Н.В., Бухтин К.М. Применение ривароксабана для профилактики тромбоэмболических осложнений после эндопротезирования крупных суставов в условиях реальной клинической практики в России (по данным проспективного многоцентрового неинтервенционного исследования сопрано). Вестник травматологии и ортопедии им. Н.Н. Приорова. 2015;(1):84-90. Zagorodniy N.V., Bukhtin K.M. [Use of rivaroxaban for prevention of thromboembolism after major joints arthroplasty under conditions of real clinical practice in Russia (on the data of prospective multicenter noninterventional study SOPRANO)]. Vestnik travmatologii i ortopedii imeni N.N. Priorova [Reporter of Traumatology and Orthopedics named Priorov]. 2015;(1):84-90. (in Russian).
  29. Слободской А.Б., Богородский А.Ю., Осинцев Е.Ю., Лежнев А.Г. Комплексная профилактика тромбоэмболий и ранних кровотечений в послеоперационном периоде при артропластике крупных суставов Стационарозамещающие технологии: Амбулаторная хирургия. 2014;(3-4):21-25. Slobodskoi A.B., Bogorodskii A.Yu., Osintsev E.Yu., Lezhnev A.G. [Complex prophylaxis of thromboembolism and early bleeding in the postoperative period with arthroplasty of large joints]. Statsionarozameshchayushchie tekhnologii: Ambulatornaya khirurgiya [Stationary replacement technologies: Outpatient surgery]. 2014;(3-4):21-25. (in Russian).
  30. Brimmo O., Glenn M., Klika A., Murray T., Molloy R., Higuera C. Rivaroxaban use for thrombosis prophylaxis is associated with early periprosthetic joint infection. J Arthroplasty. 2016;31(6):1295-1298. doi: 10.1016/j.arth.2015.12.027.
  31. Rath N.K., Goodson M.W., White S.P., Forster M.C. The use of rivaroxaban for chemical thromboprophylaxis following total knee replacement. Knee. 2013;20(6): 397-400. doi: 10.1016/j.knee.2013.01.006.
  32. Jensen C., Steval A., Partington P., Reed M., Muller S. Return to theatre following total hip and knee replacement, before and after the introduction of rivaroxaban: a retrospective cohort study. J Bone Joint Surg Br. 2010;93(1):91-95. doi: 10.1302/0301-620X.93B1.24987.
  33. Jameson S.S., Rymaszewska M., Hui A.C., James P., Serrano-Pedraza I., Muller S.D. Wound complications following rivaroxaban administration: a multicenter comparison with low-molecular-weight heparins for thromboprophylaxis in lower limb arthroplasty. J Bone Joint Surg Am. 2012;94(17):1554-1558. doi: 10.2106/JBJS.K.00521.
  34. Lassen M., Haas S., Kreutz R., Mantovani L., Holberg G., Turpie A. Rivaroxaban for thromboprophylaxis after fracturerelated orthopedic surgery in routine clinical practice. Clin Appl Thromb Hemost. 2016;22(2):138-146. doi: 10.1177/1076029615607303.
  35. Russell R., Huo M. Apixaban and rivaroxaban decrease deep venous thrombosis but not other complications after total hip and total knee arthroplasty. J Arthroplasty. 2013; 28(9):1477-1481. doi: 10.1016/j.arth.2013.02.016.
  36. Huang J., Cao Y., Liao C., Wu L., Gao F. Apixaban versus enoxaparin in patients with total knee arthroplasty. A metaanalysis of randomised trials. Thromb Haemost. 2011;105(2):245-253. doi: 10.1160/TH10-08-0552.
  37. Aryal M.R., Pandit A., Ghimire S., Pathak R., Karmacharya P., Poudel D.R., Shamoun F.E. Thromboprophylaxis with apixaban and the risk of pulmonary embolism in patients undergoing knee replacement surgery. J Community Hosp Intern Med Perspect. 2015;5(4):27889. doi: 10.3402/jchimp.v5.27889.
  38. Pedersen A.B., Mehnert F., Johnsen S.P., Husted S., Sorensen H.T. Venous thromboembolism in patients having knee replacement and receiving thromboprophylaxis: a Danish populationbased followup study. J Bone Joint Surg Am. 2011;93(14):1281-1287. doi: 10.2106/JBJS.J.00676.
  39. Guijarro R., Montes J., San Román C., Arcelus J.I., Barillari G., Granero X., Monreal M. Venous thromboembolism and bleeding after total knee and hip arthroplasty. Findings from the Spanish National Discharge Database. Thromb Haemost. 2011;105(4): 610-615. doi: 10.1160/TH10-10-0645.
  40. Zanasi R., Fioretta G., Ciocia G., Bergonzi M. Prevention of deep venous thrombosis in orthopedic surgery: effects of defibrotide. Clin Ther. 1988;10(4):350-357.
  41. Kim Y.H., Choi I.Y., Park M.R., Park T.S., Cho J.L. Deep vein thrombosis after uncemented total hip replacement. Bull Hosp Jt Dis. 1997;56(3):133-139.
  42. Freedman K.B., Brookenthal K.R., Fitzgerald R.H.Jr, Williams S., Lonner J.H. A meta-analysis of thromboembolic prophylaxis following elective total hip arthroplasty. J Bone Joint Surg Am. 2000;82-A(7):929-938.
  43. Prevention of pulmonary embolism and deep vien thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet. 2000 15;355(9212):1295-1302.
  44. Sahebally S.M., Healy D., Walsh S.R. Aspirin in the primary prophylaxis of venous thromboembolism in surgical patients. Surgeon. 2015;13(6):348-358. doi: 10.1016/j.surge.2015.05.001.
  45. An V.V., Phan K., Levy Y.D., Bruce W.J. Aspirin as thromboprophylaxis in hip and knee arthroplasty: a systematic review and metaanalysis. J Arthroplasty. 2016;31(11):2608-2616. doi: 10.1016/j.arth.2016.04.004.
  46. Anderson D.R., Dunbar M.J., Bohm E.R., Belzile E., Kahn S.R. et al. Aspirin versus low-molecular-weight heparin for extended venous thromboembolism prophylaxis after total hip arthroplasty: a randomized trial. Ann Intern Med. 2013;158(11):800-806. doi: 10.7326/0003-4819-158-11-201306040-00004.
  47. Raphael I.J., Tischler E.H., Huang R., Rothman R.H., Hozack W.J., Parvizi J. Aspirin: an alternative for pulmonary embolism prophylaxis after arthroplasty? Clin Orthop Relat Res. 2014;472(2):482-488. doi: 10.1007/s11999-013-3135-z.
  48. Ornelas A., ZachariasMillward N., Menter D.G., Davis J.S., Lichtenberger L., Hawke D., Hawk E., Vilar E., Bhattacharya P., Millward S. Beyond COX1: the effects of aspirin on platelet biology and potential mechanisms of chemoprevention. Cancer Metastasis Rev. 2017. 36(2):289-303. doi: 10.1007/s10555-017-9675-z.
  49. van Ryn J., Stangier J., Haertter S., Liesenfeld K.H., Wienen W., Feuring M., Clemens A. Dabigatran etexilate – a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost. 2010;103(6):1116-1127. doi: 10.1160/TH09-11-0758.
  50. Salmela B., Joutsi-Korhonen L., Armstrong E., Lassila R. Active online assessment of patients using new oral anticoagulants: bleeding risk, compliance, and coagulation analysis. Semin Thromb Hemost. 2012;38(1): 23-30. doi: 110.1055/s-0031-1300948.
  51. Graff J., von Hentig N., Misselwitz F., Kubitza D., Becka M., Breddin H.K., Harder S. Effects of the oral, direct factor Xa inhibitor rivaroxaban on plateletinduced thrombin generation and prothrombinase activity. J Clin Pharmacol. 2007;47(11):1398-1407. doi: 10.1177/0091270007302952.
  52. Lindhoff-Last E., Samama M.M., Ortel T.L., Weitz J.I., Spiro T.E. Assays for measuring rivaroxaban: their suitability and limitations. Ther Drug Monit. 2010;32(6): 673-679. doi: 10.1097/FTD.0b013e3181f2f264.

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