Acute and chronic anticoagulation therapy in relation to joint replacements

Czech version

Authors: Jaroslav Malý
Authors‘ workplace: IV. interní hematologická klinika LF UK a FN Hradec Králové, přednosta doc. MUDr. Pavel Žák, Ph. D.
Published in: Vnitř Lék 2015; 61(6): 574-581
Category:

Předneseno na mezioborovém sympoziu s postgraduálním zaměřením „Diabetik – společný pacient diabetologa a ortopeda“ 10. října 2014 v Hradci Králové

Overview

Thromboembolic disease (TED) is a considerable social and health problem. The solution evidently consists in the prevention of TED in clinical fields, not in the treatment itself. We can assume that effective prevention consequently reduces the cost of the following treatment. A lethal pulmonary embolism (PE) can be the first and the final clinical manifestation in patients with an asymptomatic deep venous thrombosis. This makes the systematic prevention of venous thromboembolism in higher risk patients necessary. Unfortunately, pharmacological prevention has been used less than would be needed. Inseparable from the TED prevention are physical methods. Pharmacological possibilities of the thromboembolic disease prevention were significantly extended within the past decade. To ensure the TED prevention after the total replacement (TEP) of hip and knee joints the following rules need to be observed: the TED prevention should be effected with LMWH, fondaparinux, dabigatran, rivaroxaban or apixaban for a period of 28-35 days after the hip joint replacement surgery and for 14 days after the knee joint replacement. The use of ASA, dextran and UFH as a thromboprophylaxis after the hip and knee joint TEP is not justified within the Czech Republic. Physical means (graduated compression stockings or IPC) can be used to support the recommended pharmacological treatment, they should not be used individually except in cases where pharmacological thromboprophylaxis is contraindicated.

Key words:
apixaban – dabigatran – LMWH – rivaroxaban – total hip and knee joint replacement – thromboembolic disease

Sources

1. Cohen AT, Tapson VF, Bergmann JF et al. ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008; 371(9610): 387–394.

2. Malý J, Penka M, Gumulec J et al. Shrnutí doporučených operačních postupů pro prevenci žilní tromboembolické nemoci u rizikových nemocných. In: Malý J; Kessler P; Gumelec J (eds). Trendy v profylaxi žilní tromboembolické nemoci. 2. ed. Mladá fronta: Praha 2013. ISBN 978–80–204–2878–3.

3. Gustafsson D. Oral direct thrombin inhibitors in clinical development. J Intern Med 2003; 254(4): 322–334.

4. Mungall D. BIBR-1048 Boehringer Ingelheim. Curr Opin Investig Drugs 2002; 3(6): 905–907.

5. Stangier J, Rathgen K, Stähle H et al. The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjects. Br J Clin Pharmacol 2007; 64(3): 292–303.

6. Stangier J, Stähle H, Rathgen K et al. Pharmacokinetics and pharmacodynamics of the direct oral thrombin inhibitor dabigatran in healthy elderly subjects. Clin Pharmacokinet 2008; 47(1): 47–59.

7. Eriksson BI, Dahl OE, Ahnfelt L et al. Dose escalating safety study of a new oral direct thrombin inhibitor, dabigatran etexilate, in patients undergoing total hip replacement: BISTRO I. J Thromb Haemost 2004; 2(9): 1573–1580.

8. Eriksson BI, Dahl OE, Rosencher N et al. Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J Thromb Haemost 2007; 5(11): 2178–2185.

9. Ageno W, Gallus AS, Wittkowsky A et al. American College of Chest Physicians Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141(2 Suppl): e44S-e88S. Dostupné z DOI: <http://dx.doi.org/10.1378/chest.11–2292>.

10. Huo M, Eriksson B, Dahl O et al. RE-NOVATE II Study Group. Oral dabigatran versus enoxaparin for thromboprophylaxis after primary total hip arthroplasty (RE-NOVATE II*). A randomised, double-blind, non-inferiority trial.Abstract: Thromb Haemost 2011; 105(4): 721–729. Dostupné z DOI: <http://dx.doi.org/10.1160/TH10–10–0679 >.

11. Schulman S, Kearon C, Kakkar AK et al. RE-COVER Study Group. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 2009; 361(24): 2342–2352.

12. Samama MM. The mechanism of action of rivaroxaban – an oral, direct Factor Xa inhibitor – compared with other anticoagulants. Thromb Res 2011; 127(6): 497–504.

13. Samama MM, Martinoli JL, Le Flem L et al. Assessment of laboratory assays to measure rivaroxaban – an oral, direct Factor Xa inhibitor. Thromb Haemost 2010; 103(4): 815–825.

14. Stampfuss J, Kubitza D, Becka M et al. The effect of food on the absorption and pharmacokinetics of rivaroxaban. Int J Clin Pharmacol Ther 2013; 51(7): 549–561.

15. Eriksson BI, Borris LC, Friedman RJ et al. RECORD1 Study Group. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med 2008; 358(26): 2765–2775.

16. Lassen MR, Ageno W, Borris LC et al. RECORD3 Investigators. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. Engl J Med 2008; 358(26): 2776–2786.

17. Eriksson BI, Kakkar AK, Turpie AGG et al. Oral rivaroxaban for the prevention of symptomatic venous thromboembolism after elective hip and knee replacement. J Bone Joint Surg Br 2009; 91(5): 636–644.

18. Kakkar AK, Brenner B, Dahl OE et al. RECORD 2 investigators. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet 2008; 372(9632): 31–39.

19. Turpie AGG, Lassen MR, Davidson BL et al. RECORD 4 Investigators. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. Lancet 2009; 373(9676): 1673–1680.

20. Wong PC, Crain EJ, Xin B et al. Apixaban, an oral, direct and highly selective factor Xa inhibitor: in vitro, antithrombotic and antihemostatic studies. J Thromb Haemost 2008; 6(5): 820–829.

21. Bultas J, Karetova D. Apixaban. Remedia 2011; 21(4): 304–313.

22. Tun NM, Oo TH. Prevention and treatment of venous thromboembolism with new oral anticoagulants: a practical update for clinicians. Thrombosis.2013; 2013: 183616. Dostupné z DOI: <http://dx.doi.org/10.1155/2013/183616>.

23. Lassen MR, Raskob GE, Gallus A et al. Apixaban or Enoxaparin for Thromboprophylaxis after Knee Replacement. N Engl J Med 2009; 361(6): 594–604.

24. Lassen MR, Raskob GE, Gallus A et al. Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. Lancet 2010; 375(9717): 807–815.

25. Lassen MR, Gallus A, Raskob GE et al. Apixaban versus enoxaparin for thromboprophylaxis after hip replacement. N Engl J Med 2010; 363(26): 2487–2498.

26. Malý J, Penka M, Gumulec J et al. Shrnutí doporučených operačních postupů pro prevenci žilní tromboembolické nemoci u rizikových nemocných. In: Malý J; Kessler P; Gumelec J (eds). Trendy v profylaxi žilní tromboembolické nemoci. 2. ed. Mladá fronta: Praha 2013. ISBN 978–80–204–2878–3.