Return to theatre following total hip and knee replacement, before and after the introduction of rivaroxaban

Jensen, Cyrus D.; Steval, A.; Partington, Paul; Reed, M; Müller, Susanne

doi:10.1302/0301-620x.93b1.24987

Cited by 96 publications

(76 citation statements)

References 28 publications

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“…A pooled analysis of the 4 trials, however, indicated a very small increase in bleeding, 26 an issue of particular concern to some orthopedic surgeons who will also be reticent in initiating immediate-acting anticoagulants until 12 to 24 hours postoperatively. 27 Rivaroxaban nonetheless is a convenient and highly effective agent for the prevention of venous thrombosis after total hip or knee replacement (see Table 3 for dose/schedule) and is a good alternative to anticoagulants that require subcutaneous injections (eg, LMWHs, fondaparinux) or regular laboratory monitoring (eg, warfarin).…”

Section: Rivaroxaban In the Prevention And Treatment Of Vtementioning

confidence: 99%

Pros and cons of new oral anticoagulants

2013

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The availability of new oral anticoagulants (NOACs) targeting either thrombin (dabigatran etexilate) or factor Xa (rivaroxaban and apixaban) for the prevention and treatment of thrombosis has been highly anticipated. NOACs have major pharmacologic advantages over vitamin K antagonists (eg, warfarin), including rapid onset/offset of action, few drug interactions, and predictable pharmacokinetics, eliminating the requirement for regular coagulation monitoring. Regulatory agencies have approved several NOACs for specific indications based on the results of clinical trials demonstrating efficacy and safety that are at least as good, if not better, than warfarin (for stroke prevention in atrial fibrillation and treatment and secondary prevention of venous thromboembolism) or low-molecular-weight heparin, which is injectable (for initial treatment of venous thromboembolism and thromboprophylaxis in patients undergoing hip or knee arthroplasty). However, the adoption of this new therapeutic class into clinical practice has been slower than expected due to several factors including concerns regarding medication adherence without laboratory monitoring, uncertainty about dosing in some patient populations (eg, renal dysfunction, marked extremes of body weight), and higher drug costs compared with warfarin. Other issues are the current absence of specific antidotes for NOACs and assays to measure drug levels at most centers. The indications for NOACs on the market will expand and at least one additional agent (edoxaban) will likely gain approval within the next 2 years. As practitioners gain familiarity with the drugs and healthcare systems adapt to their use, NOAC use will increase substantially over time. Warfarin, however, will continue to be an appropriate anticoagulant choice for many patients.

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Section: Rivaroxaban In the Prevention And Treatment Of Vtementioning

confidence: 99%

Pros and cons of new oral anticoagulants

2013

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“…No difference in major bleeding events between both group (0.7 % vs 0.3 %; P=0.109). In the latest retrospective review, Jensen et al [42] associated rivaroxaban with more reoperations than LMWH after TKA (3.94 % vs 1.8 %; P= 0.046).…”

Section: Rivaroxabanmentioning

confidence: 99%

Venous Thromboembolism (VTE) Prophylaxis for Hip and Knee Arthroplasty: Changing Trends

Budhiparama¹,

Abdel

Ifran³

et al. 2014

Curr Rev Musculoskelet Med

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“…Wound complications including excessive wound hematoma, surgical site bleeding, and postsurgical wound infection were similar between rivaroxaban and enoxaparin in a pooled analysis of RECORD 1 and 2 [65] . However, the potential for an increased risk of wound complications associated with rivaroxaban has been brought into question by several recent institutional studies [66][67][68][69][70] . In a multicenter analysis of 13123 major orthopedic surgery patients (including 5974 THA), Jameson et al [69] found an increased rate of wound complications including hematoma, superficial wound infection, and deep infection requiring return to surgery, with rivaroxaban compared to enoxaparin use (3.85% vs 2.81%, P = 0.005).…”

Section: Post-surgical Vte After Elective Major Orthopedic Surgery Ofmentioning

confidence: 99%

New oral pharmacotherapeutic agents for venous thromboprophylaxis after total hip arthroplasty

Aikens

Osmundson

Rivey

2014

WJO

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Patients undergoing total hip arthroplasty (THA) are at high risk for developing venous thromboembolism and, therefore, require short term prophylaxis with antithrombotic agents. Recently, target specific oral anticoagulants (TSOA) including the direct thrombin inhibitor, dabigatran, and the factor Ⅹa inhibitors rivaroxaban, apixaban, and edoxaban have been approved for THA thrombopropylaxis in various countries. The TSOAs provide a rapid acting, oral alternative to parenteral agents including low-molecular weight heparins (LMWH) and fondaparinux; and compared to warfarin, they do not require routine laboratory monitoring and possess much fewer drug-drug interactions. Based on phase Ⅲ clinical studies, TSOAs have established themselves as an effective and safe option for thromboprophylaxis after THA compared to LMWH, particularly enoxaparin, but require additional evaluation in specific populations such as the renally impaired or elderly. The ability to monitor and reverse these TSOAs in the case of bleeding complications or suspected sub-or supra-therapeutic anticoagulation is of importance, but remains investigational. This review will focus on the drug-specific characteristics, efficacy, safety, and economic impact of the TSOAs for thromboprophylaxis following THA, as well as the aspects of therapeutic monitoring and anticoagulation reversal in the event of bleeding complications or a need for urgent reversal. Key words: Oral; Thromboprophylaxis; Venous thromboembolism; Hip; Arthroplasty Core tip: This review focuses on the drug-specific characteristics, efficacy, safety, and economic impact of the target specific oral anticoagulants including dabigatran, rivaroxaban, apixaban, and edoxaban for thromboprophylaxis following total hip arthroplasty, as well as the aspects of therapeutic monitoring and anticoagulation reversal in the event of bleeding complications or a need for urgent reversal.Aikens GB, Osmundson JR, Rivey MP. New oral pharmacotherapeutic agents for venous thromboprophylaxis after total hip arthroplasty. World J Orthop 2014; 5(3): 188-203 Available from:

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Return to theatre following total hip and knee replacement, before and after the introduction of rivaroxaban

Cited by 96 publications

References 28 publications

Pros and cons of new oral anticoagulants

Pros and cons of new oral anticoagulants

Venous Thromboembolism (VTE) Prophylaxis for Hip and Knee Arthroplasty: Changing Trends

New oral pharmacotherapeutic agents for venous thromboprophylaxis after total hip arthroplasty

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