Risks of major bleeding and venous thromboembolism in patients undergoing total hip or total knee arthroplasty using therapeutic dosages of DOACs

被引:0
作者
Smeets, Mark J. R. [1 ,2 ]
Kristiansen, Eskild Bendix [2 ,3 ]
Nemeth, Banne [1 ,4 ]
Huisman, Menno V. [5 ]
Cannegieter, Suzanne C. [1 ,5 ]
Pedersen, Alma Becic [2 ,3 ]
机构
[1] Leiden Univ, Med Ctr, Dept Clin Epidemiol, Leiden, Netherlands
[2] Aarhus Univ Hosp, Dept Clin Epidemiol, Aarhus, Denmark
[3] Aarhus Univ Hosp, Dept Clin Med, Aarhus, Denmark
[4] Leiden Univ, Med Ctr, Dept Orthopaed Surg, Leiden, Netherlands
[5] Leiden Univ, Med Ctr, Dept Internal Med Thrombosis & Hemostasis, Leiden, Netherlands
关键词
Arthroplasty; replacement; hip; knee; Factor xa inhibitors; Hemorrhage; Venous thromboembolism; FACTOR-XA INHIBITOR; DIRECT THROMBIN INHIBITOR; DABIGATRAN ETEXILATE; THROMBOPROPHYLAXIS; PREVENTION; REPLACEMENT; BAY-59-7939; RIVAROXABAN; SAFETY; PROPHYLAXIS;
D O I
10.1007/s11239-024-03015-9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
About 1.5% of patients undergoing total hip (THA) or total knee arthroplasty (TKA) still develop postoperative venous thromboembolism (VTE), indicating that the current thromboprophylaxis strategy is not optimal. To evaluate the feasibility of therapeutic dosages of direct oral anticoagulants (DOACs) as thromboprophylaxis for high VTE risk patients, we determined the risks of major bleeding and VTE in patients who underwent THA/TKA and were treated with DOACs in therapeutic dosages for atrial fibrillation (AF). We conducted a registry-based cohort study from 2010 to 2018 in Denmark and included AF patients on therapeutic DOACs dose who underwent THA/TKA. AF patients were utilized as proxy since they have a life-long indication for therapeutic anticoagulant medication. The 49-days cumulative incidence (with death as competing risk) of major bleeding was assessed. The same was done for VTE at 49- and 90-days. 1,354 THA and TKA procedures were included. The 49-days cumulative incidence of major bleeding was 1.40% (95%Confidence Interval[CI] 0.88-2.14%). Most bleeding events occurred at the surgical site. The cumulative incidence of VTE at 49-days was 0.59% (95%CI 0.28-1.13%) and 0.74% (95%CI 0.38-1.32%) at 90-days. The incidence of major bleeding in THA/TKA patients on DOACs in therapeutic dosages was in line with previously reported incidences among THA/TKA patients on thromboprophylaxis dosages, while the incidence of VTE was relatively low. These data provide a solid basis for the design of randomized controlled trials to establish the safety and efficacy of therapeutic dosages of DOACs to prevent VTE in high-risk patients. center dot Some arthroplasty patients still develop venous thromboembolism (VTE), despite thromboprophylaxis.center dot We assessed the feasibility of DOACs used in therapeutic dosage as thromboprophylaxis in high-risk THA/TKA patients.center dot Observed risks of major bleeding and VTE were 1.40% (49-days) and 0.74% (90-days), respectively.center dot A randomized clinical trial investigating the possible benefit of therapeutic dosages of DOACs as prophylactic strategy in high-risk arthroplasty patients seems a feasible next step.
引用
收藏
页码:1249 / 1255
页数:7
相关论文
共 50 条
[41]   Thromboprophylaxis in patients undergoing total hip and knee arthroplasty: a review of current practices in an Australian teaching hospital [J].
Pow, R. E. ;
Vale, P. R. .
INTERNAL MEDICINE JOURNAL, 2015, 45 (03) :293-299
[42]   Does the form of venous thromboembolism prophylaxis following primary total knee arthroplasty alter the rate of early reoperation or revision surgery? [J].
Kerr, David L. ;
Butler, Stephen ;
Read, Andrew C. ;
Harris, Ian A. .
ANZ JOURNAL OF SURGERY, 2019, 89 (10) :1211-1216
[43]   Homocysteine and its relationship to deep venous thrombosis in patients undergoing total knee or hip arthroplasty [J].
Mouravas, H. ;
Verettas, D. ;
Kazakos, K. ;
Xarhas, K. ;
Panagiotou, N. ;
Ellinas, P. .
HIPPOKRATIA, 2010, 14 (03) :185-188
[44]   Therapeutic potential of apixaban in the prevention of venous thromboembolism in patients undergoing total knee replacement surgery [J].
Imberti, Davide ;
Gallerani, Massimo ;
Manfredini, Roberto .
JOURNAL OF THROMBOSIS AND THROMBOLYSIS, 2012, 34 (02) :208-213
[45]   Total Hip Arthroplasty in Patients Who Have Factor V Leiden: Elevated Risks Isolated to Venous Thromboembolism Events [J].
Sanchez, Joshua G. ;
Jiang, Will M. ;
Dhodapkar, Meera M. ;
Radford, Zachary J. ;
Rubin, Lee E. ;
Grauer, Jonathan N. .
JOURNAL OF ARTHROPLASTY, 2024, 39 (10) :2421-2426
[46]   Is Apixaban Safe and Effective for Venous Thromboembolism Prophylaxis After Primary Total Hip and Total Knee Arthroplasties? [J].
Rooney, Timothy ;
Barrack, Robert L. ;
Clohisy, John C. ;
Nunley, Ryan M. ;
Lawrie, Charles M. .
JOURNAL OF ARTHROPLASTY, 2021, 36 (07) :S328-S331
[47]   Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty [J].
Singh, Jasvinder A. ;
Jensen, Matthew R. ;
Harmsen, William Scott ;
Gabriel, Sherine E. ;
Lewallen, David G. .
ANNALS OF THE RHEUMATIC DISEASES, 2011, 70 (12) :2082-2088
[48]   Prevention of Venous Thromboembolism in Total Knee and Hip Replacement [J].
Warwick, David .
CIRCULATION, 2012, 125 (17) :2151-2155
[49]   Stress-induced hyperglycaemia and venous thromboembolism following total hip or total knee arthroplasty Analysis from the RECORD trials [J].
Cohn, Danny M. ;
Hermanides, Jeroen ;
DeVries, J. Hans ;
Kamphuisen, Pieter-Willem ;
Kuhls, Silvia ;
Homering, Martin ;
Hoekstra, Joost B. L. ;
Lensing, Anthonie W. A. ;
Buller, Harry R. .
THROMBOSIS AND HAEMOSTASIS, 2012, 107 (02) :225-231
[50]   Dabigatran etexilate and concomitant use of non-steroidal anti-inflammatory drugs or acetylsalicylic acid in patients undergoing total hip and total knee arthroplasty: No increased risk of bleeding [J].
Friedman, Richard J. ;
Kurth, Andreas A. ;
Clemens, Andreas ;
Noack, Herbert ;
Eriksson, Bengt I. ;
Caprini, Joseph A. .
THROMBOSIS AND HAEMOSTASIS, 2012, 108 (01) :183-190