Bleeding complications after systematic switch of routine thromboprophylaxis for major orthopaedic surgery

Kistler, Urs; Quervain, Inès Kramers-de; Munzinger, U.; Kucher, Nils

doi:10.1160/th08-01-0019

Cited by 9 publications

(7 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In VWD patients who underwent a surgical intervention, we also found that elderly patients reported more post‐surgical bleeding than younger ones, possibly because they had undergone more major surgical procedures, such as orthopedic surgery, which is characterized by a high bleeding risk . Indeed, in our cohort more orthopedic interventions were performed in elderly patients than in younger ones (22/64, 34% vs. 104/495, 21%; P = 0.019).…”

Section: Discussionmentioning

confidence: 52%

von Willebrand disease and aging: an evolving phenotype

Sanders

Giezenaar

Gorkom

et al. 2014

Journal of Thrombosis and Haemostasis

136

View full text Add to dashboard Cite

Summary. Background: Because the number of elderly von Willebrand disease (VWD) patients is increasing, the pathophysiology of aging in VWD has become increasingly relevant. Objectives: To assess age-related changes in von Willebrand factor (VWF) and factor VIII (FVIII) levels and to compare age-related differences in bleeding phenotype between elderly VWD patients and those < 65 years. We also studied co-morbidity in elderly patients. Patients/ Methods: We included VWD patients with VWF levels ≤ 30 U dL À1 in the nationwide cross-sectional 'Willebrand in the Netherlands' (WiN-) study. Patients reported bleeding episodes and treatment of VWD in the year preceding inclusion and during life. This was compared between VWD patients older (n = 71) and younger (16-64 years, n = 593) than 65 years. In elderly patients, agerelated changes in VWF and FVIII levels were studied longitudinally by including all historically measured levels. All medical records were examined for co-morbidity. Results: In elderly type 1 patients, a decade age increase was associated with a 3.5 U dL À1 (95% CI, À0.6 to 7.6) VWF:Ag increase and 7.1 U dL À1 (95% CI, 0.7 to 13.4) FVIII:C increase. This increase was not observed in elderly type 2 patients. Elderly type 2 patients reported significantly more bleeding symptoms in the year preceding inclusion than younger patients (16/27, 59% vs. 87/ 221, 39%; P = 0.048), which was not observed in type 1 VWD. Conclusions: von Willebrand factor parameters and bleeding phenotype evolve with increasing age in VWD. VWF and FVIII levels increase with age in type 1 patients with no mitigation in bleeding phenotype. In type 2 patients VWF parameters do not increase with age and in these patients aging is accompanied by increased bleeding.

show abstract

Section: Discussionmentioning

confidence: 52%

von Willebrand disease and aging: an evolving phenotype

Sanders

Giezenaar

Gorkom

et al. 2014

Journal of Thrombosis and Haemostasis

136

View full text Add to dashboard Cite

show abstract

“…In a cohort study by Kistler et al (26), a change of thromboprophylaxis regimen in hip and knee replacement surgery did not impact the rates of bleeding complications. They reported bleeding complications in about 1.6 to 2.5% of patients, but found no significant impact of the type of thromboprophylaxis on VTE or bleeding rates or the rates of surgical complications.…”

Section: Safety Of Thromboprophylaxis With Lmwh or Rivaroxabanmentioning

confidence: 90%

Efficacy and safety of thromboprophylaxis with low-molecular-weight heparin or rivaroxaban in hip and knee replacement surgery

Beyer‐Westendorf¹,

Lützner²,

Donath³

et al. 2013

Thromb Haemost

View full text Add to dashboard Cite

Prospective trials have shown that rivaroxaban thromboprophylaxis is superior over low-molecular-weight heparin (LMWH) in patients undergoing hip and knee replacement surgery. However, patients treated under trial conditions are different from unselected routine patients, which may affect efficacy and safety of thromboprophylaxis. The objective was to evaluate the efficacy and safety of rivaroxaban or LMWH thromboprophylaxis in unselected patients undergoing hip and knee replacement surgery in daily care. In a monocentric, retrospective cohort study in 5,061 consecutive patients undergoing hip and knee replacement surgery a comparison of LMWH (hospital standard in 2006-2007) and rivaroxaban (since 2009) was made with regard to rates of symptomatic VTE, bleeding and surgical complications and length of hospital stay. Rates of symptomatic VTE were 4.1 % (LMWH) and 2.1 % (rivaroxaban; p=0.005) with rates for distal DVT 2.5 vs. 1.1 % (p<0.001). Rates of major VTE were numerically higher with LMWH (1.7 vs. 1.1%, not statistically significant). Rates of major bleeding (overt bleeding leading to surgical revision or death, occurring in a critical site, or transfusion of at least two units of packed red blood cells) were statistically lower with rivaroxaban (2.9 vs. 7.0%; p<0.001). Rivaroxaban patients had fewer surgical complications (1.1 vs. 3.7%; p<0.001) and a shorter length of hospitalisation (8.3 days; 95% CI 8.1- 8.5 vs. 11.1 days; 10.7- 11.5; p< 0.001). We conclude that rivaroxaban thromboprophylaxis is more effective than LMWH in unselected patients undergoing hip and knee replacement surgery in daily care and that switching from LMWH to rivaroxaban could be beneficial. Prospective comparisons are warranted to confirm our findings.

show abstract

“…Medical literature demonstrates a large heterogeneity in the reported rates of major and minor bleeding during extended thromboprophylaxis with LMWH in patients undergoing major orthopedic surgery 1, 2–10, 11–14, 39–41. Freedman et al 1 in their meta‐analysis reported a risk of minor wound‐bleeding and major wound‐bleeding of, respectively, 8.9% and 1.51% following an elective total hip arthroplasty.…”

Section: Discussionmentioning

confidence: 99%