Comparison of ximelagatran with warfarin for the prevention of venous thromboembolism after total knee replacement

Francis, Charlie; Berkowitz, Scott D.

doi:10.1016/j.accreview.2003.12.019

Cited by 86 publications

(105 citation statements)

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“…59 Ximelagatran at a dose of 36 mg significantly reduced the rate of overall DVT from 27.6% to 20.3%. The rate of DVT with 24 mg ximelagatran was similar to that seen in warfarin patients.…”

Section: Elective Total Knee Replacementmentioning

confidence: 99%

Prevention of Venous Thromboembolism in Surgical Patients

2004

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Abstract-Venous thromboembolism (VTE) is a common complication of surgical procedures. The risk for VTE in surgical patients is determined by the combination of individual predisposing factors and the specific type of surgery. Prophylaxis with mechanical and pharmacological methods has been shown to be effective and safe in most types of surgery and should be routinely implemented. For patients undergoing general, gynecologic, vascular, and major urologic surgery, low-dose unfractionated heparin or low-molecular-weight heparin (LMWH) are the options of choice. For low-risk urologic surgery, early postoperative mobilization of patients is the only intervention warranted. For higher-risk patients, including those undergoing elective hip or knee replacement and surgery for hip fracture, vitamin K antagonists, LMWH, or fondaparinux are recommended. For patients undergoing neurosurgery, graduated elastic stockings are effective and safe and may be combined with LMWH to further reduce the risk of VTE. The role of prophylaxis is less defined in patients undergoing elective spine surgery, as well as laparoscopic and arthroscopic surgery. A number of issues related to prophylaxis of VTE after surgery deserve further clarification, including the role of screening for asymptomatic deep vein thrombosis, the best timing for initiation of pharmacological prophylaxis, and the optimal duration of prophylaxis in high-risk patients. Key Words: venous thromboembolism Ⅲ deep vein thrombosis Ⅲ pulmonary embolism Ⅲ heparin Ⅲ low-molecular-weight heparin Ⅲ vitamin K antagonists

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Section: Elective Total Knee Replacementmentioning

confidence: 99%

Prevention of Venous Thromboembolism in Surgical Patients

2004

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“…The need for a warfarin substitute has led to numerous drug development projects that have focused on inhibitors of coagulation proteases that specifically inactivate the protease active site. Ximelagatran, an oral thrombin inhibitor, was the first to show that the strategy of direct coagulation protease inhibition does translate into effective anticoagulation and leads to antithrombotic activity in deep vein thrombosis and atrial fibrillation patients [46]. Two studies suggest that ximelagatran is at least as effective as warfarin in preventing stroke in high-risk patients with atrial fibrillation [47].…”

Section: Limitations Of Anticoagulants -Oralmentioning

confidence: 99%

Therapeutic approaches in arterial thrombosis

Phillips

Conley

Sinha

et al. 2005

Journal of Thrombosis and Haemostasis

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Summary. The current standard of care for the treatment of arterial thrombosis includes anticoagulants and three classes of antiplatelet agents -aspirin, thienopyridines and glycoprotein IIb-IIIa antagonists. Although these drugs have had a significant impact on morbidity and mortality in several patient populations, up to 15% of the high risk patients with acute coronary syndrome continue to suffer from ischemic events. This problem may occur, in part, because the platelets in many patients are non-responsive to aspirin and clopidogrel. Murine models now indicate that platelets are not only responsible for arterial occlusion, they are also involved in the progression of atherosclerotic disease. New opportunities have emerged identifying potential targets and strategies for drug discovery suited to address these deficiencies by more effectively modulating platelet adhesion, thrombus growth, thrombus stability and the pro-inflammatory activity of platelets. In addition, a growing need has emerged for the development of bedside devices capable of bringing personalized medicine to patients being treated with antithrombotic drugs in order to measure the pharmacodynamic activities of new therapies, to assess the activities achieved by combined antithrombotic therapy, and to identify patients that fail to respond.

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“…Reported rates of symptomatic and asymptomatic DVT after TKA are approximately 40% to 50% when no prophylaxis is given and 16% to 27% when VTE prophylaxis is prescribed [10,13,18]. The rate of symptomatic VTE in patients undergoing TKA receiving prophylaxis is 1.3% to 2.3% [10,11,27]. The rate of PE in this population is generally reported with an incidence of less than 0.8% [6,31], although there has been inconsistency regarding the incidence of VTE in association with TJA over the last 10 to 15 years [2,16].…”

Section: Discussionmentioning

confidence: 99%