Outpatient Pharmacological Prevention of Venous Thromboembolism after Knee Joint Replacement

Kasimova A.R.

Vreden Russian Research Institute of Traumatology and Orthopedics;
Pavlov First St. Petersburg State Medical University

Bozhkova S.A.

Vreden Russian Research Institute of Traumatology and Orthopedics

Saraev A.V.

Vreden Russian Research Institute of Traumatology and Orthopedics

Shendrik N.S.

Pavlov First St. Petersburg State Medical University

Protsenko E.A.

Pavlov First St. Petersburg State Medical University

Outpatient Pharmacological Prevention of Venous Thromboembolism after Knee Joint Replacement

Authors:

Kasimova A.R., Bozhkova S.A., Saraev A.V., Shendrik N.S., Protsenko E.A.

More about the authors

Journal: Journal of Venous Disorders. 2020;14(3): 222‑229

DOI: 10.17116/flebo202014031222

Downloaded: 42

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To cite this article:

Kasimova AR, Bozhkova SA, Saraev AV, Shendrik NS, Protsenko EA. Outpatient Pharmacological Prevention of Venous Thromboembolism after Knee Joint Replacement. Journal of Venous Disorders. 2020;14(3):222‑229. (In Russ.)
https://doi.org/10.17116/flebo202014031222

Подписка 2025-2 (Journal of Venous Disorders)

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OBJECTIVE

To analyze an efficacy and safety of acetylsalicylic acid (ASA), dabigatran and rivaroxaban for prevention of venous thromboembolic complications (VTEC), as well as adherence to the recommended drug at the outpatient stage in patients after knee replacement.

MATERIAL AND METHODS

Randomized comparative study was performed. All patients received a subcutaneous injection of dalteparin sodium 2500 U for 12 hours before surgery. Then, patients were randomized into 3 groups: group A — ASA 100 mg daily, group D — dabigatran etexilate 220 mg daily, and group R — rivaroxaban 10 mg daily for 35 days after surgery. The results of outpatient prevention were evaluated in 260 patients using telephone questionnaires.

RESULTS

At the outpatient stage, the recommended drug was taken only by 76.8%, 77% and 71% of patients in groups A, D and K, respectively. Complete course of thrombosis prevention or its prolongation was confirmed in 91.5%, 98.7% and 93.1% of patients, respectively. There were no between-group differences in the incidence of adverse events, refusal to take the drug or reduction of therapeutic course.

CONCLUSION

ASA, dabigatran and rivaroxaban are similarly effective and safe for prevention of VTEC after knee joint replacement in patients without additional risk factors for VTEC.

Keywords:

thromboprophylaxis

acetylsalicylic acid

aspirin

knee joint replacement

Authors:

Kasimova A.R.

Vreden Russian Research Institute of Traumatology and Orthopedics;
Pavlov First St. Petersburg State Medical University

Bozhkova S.A.

Vreden Russian Research Institute of Traumatology and Orthopedics

Saraev A.V.

Vreden Russian Research Institute of Traumatology and Orthopedics

Shendrik N.S.

Pavlov First St. Petersburg State Medical University

Protsenko E.A.

Pavlov First St. Petersburg State Medical University

Received:

16.12.2019

Accepted:

29.04.2020

List of references:

Sobieraj DM, Coleman CI, Tongbram V, Lee S, Colby J, Chen WT, Makanji SS, Ashaye A, Kluger J, White CM. Venous Thromboembolism Prophylaxis in Orthopedic Surgery: Comparative Effectiveness Reviews [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012.
MacDougall DA, Feliu AL, Boccuzzi SJ, Lin J. Economic burden of deep-vein thrombosis, pulmonary embolism, and post-thrombotic syndrome. Am J Health Syst Pharm. 2006;63:5-15.
Lieberman JR, Heckmann N. Venous Thromboembolism Prophylaxis in Total Hip Arthroplasty and Total Knee Arthroplasty Patients: From Guidelines to Practice. J Am Acad Orthop Surg. 2017;25(12):789-798. https://doi.org/10.5435/JAAOS-D-15-00760
Freedman KB, Brookenthal KR, Fitzgerald RH Jr, Williams S, Lonner JH. A meta-analysis of thromboembolic prophylaxis following elective total hip arthroplasty. J Bone Joint Surg Am. 2000;82-A(7):929.
Migita K, Bito S, Nakamura M, Miyata S, Saito M, Kakizaki H, Nakayama Y, Matsusita T, Furuichi I, Sasazaki Y, Tanaka T, Yoshida M, Kaneko H, Abe I, Mine T, Ihara K, Kuratsu S, Saisho P K, Miyahara H,Segata T, Nakagawa Y, Kamei M, Torigoshi T, Motokawa S. Venous thromboembolism I after total joint arthroplasty: results from a Japanese multicenter cohort study. Arthritis Res R Ther. 2014;16(4):154.
Sarmiento A, Goswami A. Thromboembolic disease prophylaxis in total hip arthroplasty. Clin Orthop Relat Res. 2005;436:138-143.
Hamilton WG, Reeves JD, Fricka KB, Goyal N, Engh GA, Parks NL. Mechanical thromboembolic prophylaxis with risk stratification in total knee arthroplasty. J Arthroplasty. 2015;30(1):43-45. https://doi.org/10.1016/j.arth.2014.08.006
Parvizi J, Huang R, Raphael IJ, Arnold WV, Rothman RH. Symptomatic pulmonary embolus after joint arthroplasty: stratification of risk factors. Clin Orthop Relat Res. 2014;472(3):903-912. https://doi.org/10.1007/s11999-013-3358-z
Ast MP, Gorab AH, Banka TR, Lee L, Lyman S, Westrich GH. Clinical outcomes of patients with non-fatal VTE after total knee arthroplasty. J Arthroplasty. 2014;29(1):37-39. https://doi.org/10.1016/j.arth.2013.04.013
Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, Ortel TL, Pauker SG, Colwell CW Jr. 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(Suppl 2):278-325.
Haykal T, Kheiri B, Zayed Y, Barbarawi M, Miran MS, Chahine A, Katato K, Bachuwa G. Aspirin for venous thromboembolism prophylaxis after hip or kneearthroplasty: An updated meta-analysis of randomized controlled trials. J Orthop. 2019;16(4):294-302. https://doi.org/10.1016/j.jor.2019.03.003
Hood BR, Cowen ME, Zheng HT, Hughes RE, Singal B, Hallstrom BR. Association of Aspirin With Prevention of Venous Thromboembolism in Patients After Total Knee Arthroplasty Compared With Other Anticoagulants: A Noninferiority Analysis. JAMA Surgery. 2019;154(1):65-72. https://doi.org/10.1001/jamasurg.2018.3858
Yuenyongviwat V, Tuntarattanapong P, Chuaychoosakoon C, Iemsaengchairat C, Iamthanaporn K, Hongnaparak T. Aspirin versus rivaroxaban in postoperative bleeding after total knee arthroplasty: a retrospective case-matched study. European Journal of Orthopaedic Surgery & Traumatology: Orthopedie Traumatologie. 2019;29(4):877-881. https://doi.org/10.1007/s00590-019-02365-y
Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications (VTE). Phlebology. 2015;4(2):2-52. (In Russ.)
Nur H, Sertkaya BS, Tuncer T. Determinants of physical functioning in women with knee osteoarthritis. Aging Clin Exp Res. 2018;30(4):299-306. https://doi.org/10.1007/s40520-017-0784-x
Kasimova AR, Bozhkova SA, Tikhilov RM, Saraev AV, Petukhov AI, Zhuravkov AA, Arefyeva AN. The Effect of Pharmacological Thromboprophylaxis, Tourniquet and Drainage on Hemorrhagic Complications in the Early Stage after Knee Arthroplasty: Preliminary Results. Traumatology and Orthopedics of Russia. 2019;25(3):70-80. (In Russ.) https://doi.org/10.21823/2311-2905-2019-25-3-70-80
An VV, Phan K, Levy YD, Bruce WJ. Aspirin as Thromboprophylaxis in Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty. 2016;31(11):2608-2616. https://doi.org/10.1016/j.arth.2016.04.004
Ogonda L, Hill J, Doran E, Dennison J, Stevenson M, Beverland D. Aspirin for thromboprophylaxis after primary lower limb arthroplasty: early thromboembolic events and 90 day mortality in 11,459 patients. Bone Joint J. 2016;98-B(3):341-348. https://doi.org/10.1302/0301-620X.98B3.36511
Mostafavi Tabatabaee R, Rasouli MR, Maltenfort MG, Parvizi J. Cost-effective prophylaxis against venous thromboembolism after total joint arthroplasty: warfarin versus aspirin. J Arthroplasty. 2015;30(2):159-164. https://doi.org/10.1016/j.arth.2014.08.018
Bozhkova SA, Novokshonova AA, Drozdova PV. Aspects of the practical application of direct oral anticoagulants in traumatological and orthopedic hospital. Pirogov Russian Journal of Surgery. 2014;11:48-54. (In Russ.)
Johnson DJ, Castle JP, Harwell MJ, D’Heurle AM, Manning DW. Risk Factors for Greater Than 24-Hour Length of Stay After Primary Total Knee Arthroplasty. J Arthroplasty. 2020;35(3):633-637. https://doi.org/10.1016/j.arth.2019.10.037
Sultan AA, Samuel LT, Karnuta JM, Acuña AJ, Mahmood M, Kamath AF. Operative Times in Primary Total Knee Arthroplasty: Can We Predict the Future Based on Contemporary Nationwide Data [published online ahead of print, 2019 Nov 28]. J Knee Surg. 2019. ISSN 1538-8506. https://doi.org/10.1055/s-0039-3400949

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