Efficacy of fixed minidose warfarin prophylaxis in total hip replacement.

Fordyce, M. J. F.; Baker, A. S.; Staddon, G.E.

doi:10.1136/bmj.303.6796.219

Cited by 59 publications

(23 citation statements)

References 11 publications

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“…Such comparisons need to be interpreted more cautiously than direct comparisons ( Figure 13) because there is some potential for bias as patients in the trials had different reasons for being at risk of venous thrombosis. Fifteen trials 71,[74][75][76][77][78][79][80][81][82][83][84][85][86][87] had compared an oral anticoagulant regimen versus control, with nine [74][75][76][77][78][79][80][81][82] assessing oral anticoagulant as monotherapy and six 71,[83][84][85][86][87] as adjunctive therapy. Overall, the reduction in DVT appeared similar for moderate and lowintensity regimens, but too few patients had been assessed in trials of very low-intensity regimens for conclusions to be drawn.…”

Section: Effects Of Different Intensities Of Oral Anticoagulationmentioning

confidence: 99%

“…The effect of oral anticoagulants on PVT was reported in only seven 75,77,78,81,83,84,86 of the 15 trials assessing oral anticoagulants ( Figure 15). Overall, PVT occurred in 19 of 477 (4.0%) patients allocated to oral anticoagulants versus 40 of 496 (81%) allocated control, corresponding to a reduction of 55% (19%) in the odds of PVT (2p = 0.004), which was similar to the effect observed in DVT at any site in the leg.…”

Section: Effect Of Oral Anticoagulants On Proximal Venous Thrombosismentioning

confidence: 99%

See 1 more Smart Citation

Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis

Roderick¹,

Ferris²,

Wilson³

et al. 2005

Health Technol Assess

266

151

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Section: Effects Of Different Intensities Of Oral Anticoagulationmentioning

confidence: 99%

Section: Effect Of Oral Anticoagulants On Proximal Venous Thrombosismentioning

confidence: 99%

Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis

Roderick¹,

Ferris²,

Wilson³

et al. 2005

Health Technol Assess

266

151

View full text Add to dashboard Cite

show abstract

“…In a randomized placebo-controlled trial of 148 patients undergoing elective hip replacement, Fordyce et al (38) found an incidence of DVT of 34% with minidose warfarin and 26% with placebo. However, in their study the diagnosis of DVT was made on the basis of 125I-fibrinogen scanning supplemented by venography only if a proximal thrombosis was suspected.…”

Section: Discussionmentioning

confidence: 97%

Minidose Warfarin and Failure to Prevent Deep Vein Thrombosis After Joint Replacement Surgery Despite Inhibiting the Postoperative Rise in Plasminogen Activator Inhibitor Activity

Poller

Thomson

MacCallum

et al. 1995

Clin Appl Thromb Hemost

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In a prospective randomised study in patients undergoing elective total hip or knee replacement surgery, the antithrombotic efficacy of fixed-minidose warfarin (1 mg daily commenced 7 days before surgery) was compared with that of subcutaneous calcium heparin (Calciparine, 5,000 IU t.d.s. commenced 2 h before surgery). Both regimens were continued until venography of the operated limb was performed 9-14 days postsurgery.Venographically detected deep vein thromboses (DVTs) occurred in 15 of the 31 patients (48.4%) in the minidose warfarin group and in eight of the 37 patients (21.6%) receiving heparin. The absolute difference in the incidence of DVT was 26.8% in favour of heparin (95%l confidence interval [CI] -4.&--48.8%; p = 0.039). Proximal DVTs were detected in three patients receiving minidose warfarin and in none of those on heparin (p = 0.09). Minidose warfarin appeared to prevent the postoperative rise in the activity of plasminogen activator inhibitor (PAI) that occurred with heparin, although preoperative PAI activity was greater in the warfarin group. The prothrombin time (PT) and activated partial thromboplastin time (APTT) were within the normal range on the day of surgery in both treatment groups. Postsurgery, the minidose warfarin regimen produced a small, but significant prolongation of the PT compared with the group receiving heparin, In contrast to heparin, 1 mg warfarin daily failed to prevent postoperative acceleration of the APTT. There was no significant difference between the two regimens in bleeding complications. In conclusion, the fixed-minidose warfarin regimen cannot be recommended for prevention of DVT after hip or knee replacement surgery. Inhibition of the postoperative rise in PAI activity appears not to protect against DVT after major joint replacement surgery.

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“…In these studies, 1 mg warfarin proved effective when compared with no treatment but was less effective than standard anticoagulation (INR 2-4). Fordyce et al [64] showed no protective effect of fixed mini-dose warfarin in total hip replacement.…”

Section: Clinical Trials Of Prophylaxis Of Thromboembolic Events Withmentioning

confidence: 99%

Oral Anticoagulant Therapy: Efficacy, Safety and the Low-Dose Controversy

Coccheri¹,

Palareti²,

Cosmi³

1999

Pathophysiol Haemos Thromb

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The issue of optimal duration of oral anticoagulant therapy after a first episode of venous thromboembolism is still unresolved. However, recent data suggest that short (6 weeks to 3 months), intermediate (3– 6 months) or indefinite-term anticoagulant therapy should be adopted on the basis of the classification of patients into low-, intermediate- and high-recurrence-risk groups, respectively. Oral anticoagulants have been shown to effectively prevent cardioembolic stroke in nonvalvular atrial fibrillation. Recent data seem to suggest that their safety can be ameliorated with adequate risk stratification on the basis of clinical and echocardiographic features. After unstable angina and non-Q-wave myocardial infarction, oral anticoagulant therapy (INR range 2–3) combined with aspirin has been shown to be advantageous over aspirin alone, although at the cost of a slight increase in bleeding. Bleeding complications are major drawbacks of oral anticoagulant therapy thus limiting their generalized adoption in recognized indications. To sharply reduce the bleeding risk and need of laboratory control, the low- or fixed-dose oral anticoagulant approach has been evaluated. In primary prevention and in low or low-to-moderate thrombotic risk, minidose warfarin treatment has been shown to be advantageous. In secondary prevention, and in patients at high risk for recurrent venous or arterial thrombotic events, standard range (INR 2–3) or higher level of anticoagulation is needed.

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Efficacy of fixed minidose warfarin prophylaxis in total hip replacement.

Cited by 59 publications

References 11 publications

Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis

Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis

Minidose Warfarin and Failure to Prevent Deep Vein Thrombosis After Joint Replacement Surgery Despite Inhibiting the Postoperative Rise in Plasminogen Activator Inhibitor Activity

Oral Anticoagulant Therapy: Efficacy, Safety and the Low-Dose Controversy

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