Antithrombotic prophylaxis in major orthopaedic surgery: An historical overview and update of current recommendations

Plamen Kinov, Panayot P. Tanchev, Martin Ellis, Gershon Volpin

Research output: Contribution to journalReview articlepeer-review

20 Scopus citations

Abstract

The risk of venous thromboembolism following major orthopaedic procedures, such as joint arthroplasty and hip fracture surgery, are well recognised and represent one of the major challenges in orthopaedic practice, having in mind the increasing number of arthroplasties of the hip and knee done worldwide per year and their successful outcome. This potentially fatal complication remains a challenge in orthopaedic practice. The percentage of patients in whom antithrombotic prophylaxis has not been administrated or has been inadequate may reach 50 %. Until recently, anticoagulant prophylaxis with low molecular weight heparins (LMWHs) has been a "gold standard". LMWHs are indirect inhibitors of the clotting factors Xa and thrombin and are administered by daily subcutaneous injection. Their efficacy has been proven in numerous clinical trials and the rate of complications with their use is relatively low. However these compounds are associated with a failure rate and are inconvenient to administer, requiring subcutaneous injection, leading to inadequate compliance. For these reasons postoperative thrombembolism continues to occur in up to 10 % of this patient population. Recently, novel oral anticoagulants have been introduced into practice for thromboprophylaxis after joint arthroplasy and hip fracture surgery. These drugs are direct thrombin inhibitors (dabigatran) or direct factor Xa inhibitors (rivaroxaban, apixaban and edoxaban). These oral drugs have the same efficacy as the LMWHs with the same or slightly more clinically significant haemorrhage as their main side effect. Their ease of administration and favourable clinical profile makes them an important addition to the therapeutic armamentarium available for venous thromboprophylaxis. In this paper we review the aetiology and pathogenesis of venous thromboembolism and present the various alternatives for its prevention after major orthopaedic surgical procedures with emphasis on the new oral drugs.

Original languageEnglish
Pages (from-to)169-175
Number of pages7
JournalInternational Orthopaedics
Volume38
Issue number1
DOIs
StatePublished - Jan 2014
Externally publishedYes

Keywords

  • Aspirin
  • DVT
  • Hip fractures
  • Joint arthroplasty
  • LMWH
  • Oral anticoagulant prophylaxis
  • Thromboprophylaxis
  • Venous thromboembolism

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