Controlled Trial of Platelet Anti-Aggregating Agents and Subcutaneous Heparin in Prevention of Postoperative Deep Vein Thrombosis in High Risk Patients

Dechavanne, M; Ville, D; Viala, J. J.; Kher, A; Faivre, Jacques; Pousset, M.B.; Dejour, H

doi:10.1159/000214092

Cited by 16 publications

(8 citation statements)

References 18 publications

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“…In the 1970s and 1980s, a number of studies investigated the use of aspirin in THA, 10,[62][63][64][65] TKA, 66 and HFS. [67][68][69][70][71][72] Those studies used high doses of aspirin of up to 3.8 g daily.…”

Section: Aspirin Vs No Prophylaxis-initial Plus Extended Prophylaxis mentioning

confidence: 99%

Prevention of VTE in Orthopedic Surgery Patients

Falck‐Ytter

Francis²,

Johanson³

et al. 2012

Chest

1,700

963

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Background: VTE is a serious, but decreasing complication following major orthopedic surgery. This guideline focuses on optimal prophylaxis to reduce postoperative pulmonary embolism and DVT. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: In patients undergoing major orthopedic surgery, we recommend the use of one of the following rather than no antithrombotic prophylaxis: low-molecular-weight heparin; fondaparinux; dabigatran, apixaban, rivaroxaban (total hip arthroplasty or total knee arthroplasty but not hip fracture surgery); low-dose unfractionated heparin; adjusted-dose vitamin K antagonist; aspirin (all Grade 1B); or an intermittent pneumatic compression device (IPCD) (Grade 1C) for a minimum of 10 to 14 days. We suggest the use of low-molecular-weight heparin in preference to the other agents we have recommended as alternatives (Grade 2C/2B), and in patients receiving pharmacologic prophylaxis, we suggest adding an IPCD during the hospital stay (Grade 2C). We suggest extending thromboprophylaxis for up to 35 days (Grade 2B). In patients at increased bleeding risk, we suggest an IPCD or no prophylaxis (Grade 2C). In patients who decline injections, we recommend using apixaban or dabigatran (all Grade 1B). We suggest against using inferior vena cava fi lter placement for primary prevention in patients with contraindications to both pharmacologic and mechanical thromboprophylaxis (Grade 2C). We recommend against Doppler (or duplex) ultrasonography screening before hospital discharge (Grade 1B). For patients with isolated lowerextremity injuries requiring leg immobilization, we suggest no thromboprophylaxis (Grade 2B). For patients undergoing knee arthroscopy without a history of VTE, we suggest no thromboprophylaxis (Grade 2B). Conclusions: Optimal strategies for thromboprophylaxis after major orthopedic surgery include pharmacologic and mechanical approaches. CHEST 2012; 141(2)(Suppl):e278S-e325SAbbreviations: DUS 5 Doppler (or duplex) ultrasonography; GCS 5 graduated compression stockings; HFS 5 hip fracture surgery; INR 5 international normalized ratio; IPCD 5 intermittent pneumatic compression device; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; PEP 5 Pulmonary Embolism Prevention trial; RCT 5 randomized controlled trial; RR 5 risk ratio; THA 5 total hip arthroplasty; TKA 5 total knee arthroplasty; UFH 5 unfractionated heparin; VFP 5 venous foot pump; VKA 5 vitamin K antagonist

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Section: Aspirin Vs No Prophylaxis-initial Plus Extended Prophylaxis mentioning

confidence: 99%

Prevention of VTE in Orthopedic Surgery Patients

Falck‐Ytter

Francis²,

Johanson³

et al. 2012

Chest

1,700

963

View full text Add to dashboard Cite

show abstract

“…Thus far, four prospective randomized trials with aspirin have been published in orthopedic surgical patients [109,222,242,300] and three other reports are available in abstract from [108,117,164]. In addition, four other randomized trials have been published in which aspirin was combined with either RA 233 [287], or dipyridamole [54,178], or low-dose heparin [225], and another trial with the aspirin-dipyridamole combination has been published in abstract form [231]. All these trials were done with patients undergoing hip surgery, except for a preliminary report in which patients undergoing total knee replacement were under study [164].…”

Section: Prevention Of Venous Thromboembolism 711 General Surgery (mentioning

confidence: 99%

“…Three small randomized trials have compared a control group with either aspirin associated with RA 233 [287] or aspirin combined with dipyridamole [54,178] in patients undergoing surgery either for fracture of the femoral neck [178,287] or total hip replacement for osteoarthritis [54]. Prophylaxis was begun before surgery and diagnosis of deep vein thrombosis was determined with the 125 I-fibrinogen test.…”

Section: Aspirin Hemostasis and Thromboembolismmentioning

confidence: 99%

Acetylsalicylic Acid, Hemostasis and Human Thromboembolism

Jobin¹

2008

Semin Thromb Hemost

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“…140 Administration of dipyridamole with aspirin has been reported to significantly decrease (p < 0.05) the incident of DVT after abdominal surgery.141.142 Significant (p < 0.05) benefit from the combination also has been reported in controlled studies of patients with recurring DVT and complete lower limb paralysis resulting from spinal cord compression.P-':" On the other hand, dipyridamole plus aspirin has been proven ineffective in preventing DVT after hip surgery. [144][145][146][147] Dipyridamole alone in doses :5400 mg/d has been shown, in controlled studies, to be ineffective in preventing DVT!46.148-150 In a study in which the efficacy of dipyridamole, aspirin, warfarin, and dextran were compared, only dipyridamole failed to provide significant (p < 0.05) benefit when compared with untreated controls.!" Also, since none of the studies that demonstrated a beneficial effect from dipyridamole plus aspirin included a group receiving aspirin only, dipyridamole may have added nothing to this treatment.…”

Section: Drug Intelligence and Clinical Pharmacy 1984 Nov Vol 18 873mentioning

confidence: 99%

Dipyridamole: A Critical Evaluation

Rivey¹,

Alexander²,

Taylor³

1984

Drug Intelligence & Clinical Pharmacy

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Dipyridamole is a vasodilator that is used primarily in clinical practice as an anti platelet agent. It increases coronary blood flow and was originally introduced as an antianginal agent. An ability to prolong a shortened platelet survival has been used to justify its value in preventing thromboembolic complications. Conditions characterized by a reduction in platelet survival and where dipyridamole has been used include heart valve replacement, arterial grafting, cerebrovascular disorders, and disorders of peripheral circulation. The in vivo effect of dipyridamole on platelet aggregation has not been well defined and may depend on additional factors. Prostaglandins appear to have important roles in platelet homeostasis; their relationships to the action of dipyridamole are discussed. Dipyridamole usually is combined with aspirin for synergistic anti-aggregatory purposes. However, the nature of the interaction has not been elucidated and benefit from the addition of dipyridamole has not been demonstrated in clinical studies. A review of clinical studies using dipyridamole indicates that it currently has limited value. DIPYRIDAMOLE, a pyrimidopyrimidine compound, was marketed originally in the U.S. in 1959 as a coronary vasodilator. 1 Recognition of its ability to modify platelet function followed a short time later." It has been used to treat patients with coronary artery disease, myocardial infarction, prosthetic heart valve replacement, coronary and lower extremity arterial bypass grafting, neurological diseases, disorders of peripheral circulation, and as a diagnostic adjunct for myocardial imaging. Despite extensive use, results of clinical studies have failed to substantiate the claimed benefits of dipyridamole in many instances. It is the purpose of this article to review and evaluate data concerning the pharmacology, pharmacokinetics, and clinical efficacy of this agent.

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Controlled Trial of Platelet Anti-Aggregating Agents and Subcutaneous Heparin in Prevention of Postoperative Deep Vein Thrombosis in High Risk Patients

Cited by 16 publications

References 18 publications

Prevention of VTE in Orthopedic Surgery Patients

Prevention of VTE in Orthopedic Surgery Patients

Acetylsalicylic Acid, Hemostasis and Human Thromboembolism

Dipyridamole: A Critical Evaluation

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