Effect of 3 different anticoagulants on hidden blood loss during total hip arthroplasty after tranexamic acid

Deng, Zengfa; Zhang, Ziji; Sheng, Puyi; Fu, Ming; Xu, Danfeng; He, Anbang; Liao, Weiming; Kang, Yan

doi:10.1097/md.0000000000022028

Cited by 2 publications

(2 citation statements)

References 45 publications

(23 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Today’s standard-of-care incorporating TXA may have produced different bleeding rates. Hidden blood loss after TXA in patients receiving enoxaparin, rivaroxaban or nadroparin was not statistically significant in a trial with 150 patients 281 , but this will need further investigation.…”

Section: - Which Vte Prophylactic Agent Used In Patients Undergoing T...mentioning

confidence: 90%

“…Fibrinolysis and antifibrinolytic agents (such as TXA) may have an impact on bleeding 281-284 , and it is worth considering that many of the above-mentioned meta-analysis were based on trials performed without perioperative TXA. Today’s standard-of-care incorporating TXA may have produced different bleeding rates.…”

Section: - Which Vte Prophylactic Agent Used In Patients Undergoing T...mentioning

confidence: 99%

See 1 more Smart Citation

Recommendations from the ICM-VTE: Hip & Knee

2022

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

The ICM-VTE Hip & Knee Delegates* 1 -Is VTE after elective total joint arthroplasty a "never event"?Response/Recommendation: Venous thromboembolism (VTE) after elective total joint arthroplasty (TJA) continues to occur despite various strategies in prophylaxis and should not be considered a "never event."Strength of Recommendation: Moderate.Delegates vote: Agree 94.87% Disagree 5.13% Abstain 0.00% (Strong Consensus).Rationale: As part of an initiative to address quality of care and control healthcare costs, in 2002, the United States Centers for Medicare and Medicaid Services (CMS) defined "never events" as hospital-acquired conditions that were considered reasonably preventable 1 . In 2008, CMS added deep venous thrombosis (DVT) and pulmonary embolism (PE) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) 2 .Historically, DVT and PE were important risks for patients undergoing TJA. In a study of 7,959 patients between 1962 and 1973, Charnley et al., reported a non-fatal PE rate of 7.89% and a 1.04% rate of fatal PE which constituted the highest single cause of death after a THA 3 . Coventry et al., identified a cohort of 2012 THA from 1969 to 1971 of which 58 did not receive chemoprophylaxis past post-operative day five and observed a DVT rate of 3.4%, a non-fatal PE rate of 5.2%, and a fatal PE rate of 3.4% 4,5 . In a series performed between 1990 and 1991, Warwick et al., identified 1,162 patients undergoing THA without routine chemoprophylaxis, with DVT confirmed by venography in 1.89% of patients and a PE rate of 1.20% with a subsequent mortality rate of 0.34% 6 .Early studies demonstrated a much higher incidence of VTE for TKA 7,8 . However, DVT in TKA patients occur distally in the calf which are less likely to progress into a PE which was observed at a rate of 1.3% 9 with fatalities of 0.19 to 0.4% 9,10 . Stulburg et al., examined a series of 638 patients from 1974 to 1979 among which 49 patients inadvertently did not receive prophylaxis; an impressive 83% of these patients developed a DVT 11 .In a prospective study with 34,397 consecutive and unselected THA or TKA procedures, 32 (0.09%) had a VTE after median two days despite ongoing thromboprophylaxis 12 . All surgery was done in a fast-track setup with accelerated mobilization and discharge. Another study has shown a 90-day incidence of 0.41% of VTE after unicompartmental knee arthroplasty 13 . All patients received thromboprophylaxis until discharge and were operated in a fast-track setup with a median length of stay of one day.With VTE as a common and potentially dangerous complication after TKA and THA, safe and effective strategies for prophylaxis were developed and studied. When warfarin dosage is titrated to an international normalized ratio (INR) of 1.5 to 2.0 and administered for approximately six weeks, DVT occurred at a rate of 0.2 to 1% with a non-fatal PE rate of 0.1 to 0.3% [14][15][16] . Warfarin was found to consistently decreased rates of VTE when utilized after THA or TKA, but may lead to a significant risk ...

show abstract

Section: - Which Vte Prophylactic Agent Used In Patients Undergoing T...mentioning

confidence: 90%

Section: - Which Vte Prophylactic Agent Used In Patients Undergoing T...mentioning

confidence: 99%