Rivaroxaban or Enoxaparin in Nonmajor Orthopedic Surgery

Samama, Charles Marc; Laporte, Silvy; Rosencher, Nadia; Girard, Philippe; Llau, Juan V.; Mouret, P; Fisher, William D.; Martínez‐Martín, Javier; Duverger, Daniel; Deygas, Béatrice; Presles, Émilie; Cucherat, Michel; Mismetti, Patrick; Investigators, Pronomos

doi:10.1056/nejmoa1913808

Cited by 71 publications

(67 citation statements)

References 9 publications

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“…Fondaparinux, an indirect inhibitor of factor Xa that is injected subcutaneously and is highly effective for protection against VTE in admitted medical patients [5], was found to be more effective than and as safe as LMWH in high-risk surgical patients, such as candidates to major orthopedic surgery [6]. These findings are consistent with those achieved by several oral inhibitors of factor Xa not only in major but also in minor orthopedic surgery of the legs [6][7][8]. Unlike oral Xa inhibitors, fondaparinux does not interfere with antiviral drugs, and, therefore, it qualifies as a potential candidate to replace LMWH for prevention of thrombotic complications in high-risk patients, such as those admitted to medical departments because of a non-severe COVID-19 infectious disease.…”

supporting

confidence: 53%

The hazard of fondaparinux in non-critically ill patients with COVID-19: Retrospective controlled study versus enoxaparin

Prandoni¹,

Cattelan²,

Carrozzi

et al. 2020

Thrombosis Research

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supporting

confidence: 53%

The hazard of fondaparinux in non-critically ill patients with COVID-19: Retrospective controlled study versus enoxaparin

Prandoni¹,

Cattelan²,

Carrozzi

et al. 2020

Thrombosis Research

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“…19 Finally, the specific degradation product formed after hydrolysis by plasmin is D-D, so D-D is a specific marker that marks the body’s hypercoagulability and fibrinolytic activity. 20,21 Several studies 22,23 have pointed out that D-D for VTE detection has high sensitivity, which can be as high as 92%-100%. Some scholars 24,25 have suggested that the clinical value of D-D is mainly reflected in the elimination of patients who may have VTE during the screening process.…”

Section: Discussionmentioning

confidence: 99%

The Risk Factors of VTE and Survival Prognosis of Patients With Malignant Cancer: Implication for Nursing and Treatment

Hu²,

Chen

et al. 2020

Clin Appl Thromb Hemost

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Venous thromboembolism (VTE) is very common in patients with malignant cancer. We aimed to conduct a retrospective analysis on the risk factors of VTE and its survival prognosis of patients with malignant cancer, to provide evidence into the management of VTE. Patients with malignant cancer treated in our hospital were selected. The characteristic of patients and related lab detection results including activated partial thromboplastin time (APTT), plasma prothrombin time (PT) and thrombin coagulation time (TT), fibrinogen (FIB), thrombin AT-Ⅲ complex (TAT) and D-dimer (D-D) were collected and analyzed. And logistic regression analyses were performed to identify the potential risk factors. And ROC curves were established to evaluate their predictive ability of VTE for patients with malignant cancers. A total of 286 patients were included, of which 63 patients had VTE, the incidence of VTE in patients with malignant cancers was 22.03%. There were significant differences on the D-D, TAT level between VTE and no VTE patients (all P < 0.05). The survival condition of VTE patients was significantly worse than that of no VTE patients(P = 0.017). D-D (RR7.895, 3.228∼19.286) and TAT (6.122, 2.244∼16.695) were risk factors of VTE for patients with cancers (all P < 0.05). The area under the curve (AUC) of D-D, TAT and combined use was 0.764, 0.698, 0.794 respectively, and the cutoff value for D-D, TAT was 1.835mg/L and 4.58μg/L respectively. For cancer patients with D-D >1.835 mg/L and TAT >4.58 μg/L, early interventions are needed for the prophylaxis of VTE.

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“…A recent randomized controlled trial compared rivaroxaban with enoxaparin in a population of both elective and traumatic nonmajor orthopedic surgery patients and found a significant reduction in symptomatic VTE but no difference in bleeding. 27 Moreover, a retrospective cohort study, also using TQIP, compared DOACs and LMWH for nonoperatively managed pelvic fracture patients and reported improved effectiveness of DOACs, without increasing the risk of bleeding complications. 28 The use of DOACs for prevention of VTE in nonoperatively managed pelvic fractures, or in any trauma patient, is not an officially approved indication in the United States or in the European Union.…”

Section: Discussionmentioning

confidence: 99%

Direct Oral Anticoagulants Are a Potential Alternative to Low-Molecular-Weight Heparin for Thromboprophylaxis in Trauma Patients Sustaining Lower Extremity Fractures

Nederpelt

Breen

Hechi

et al. 2021

Journal of Surgical Research

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Background: Trauma patients are at a significant risk of venous thromboembolism (VTE), with lower extremity fractures (LEF) being independent risk factors. Use of direct oral anticoagusants (DOACs) for VTE prophylaxis is effective in elective orthopedic surgery, but currently not approved for trauma patients. The primary objective of this study was to compare the effectiveness and safety of thromboprophylaxis of DOACs with lowmolecular-weight heparin (LMWH) in trauma patients sustaining LEF. Materials and methods: We included adult trauma patients admitted to trauma quality improvement program participating trauma centers (between 2013 and 2016), who sustained LEF and were started on DOACs or LMWH for thromboprophylaxis after admission. Propensity score matching was performed to compare symptomatic VTE and bleeding control interventions between the groups. Results: Of 1,009,922 patients in trauma quality improvement program, 167,640 met inclusion criteria (165,009 received LMWH and 2631 received DOACs). After propensity score matching, 2280 predominantly elderly (median age: 67 y) isolated femur fracture patients (median ISS: 10) were included in each group (4560 patients in total). Symptomatic VTE occurred in 1.4% of patients in both matched groups (P ¼ 0.992). Bleeding control interventions occurred less often in the DOAC group, albeit statistically insignificant (5.8% versus 6.0%, P ¼ 0.772).

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Rivaroxaban or Enoxaparin in Nonmajor Orthopedic Surgery

Cited by 71 publications

References 9 publications

The hazard of fondaparinux in non-critically ill patients with COVID-19: Retrospective controlled study versus enoxaparin

The hazard of fondaparinux in non-critically ill patients with COVID-19: Retrospective controlled study versus enoxaparin

The Risk Factors of VTE and Survival Prognosis of Patients With Malignant Cancer: Implication for Nursing and Treatment

Direct Oral Anticoagulants Are a Potential Alternative to Low-Molecular-Weight Heparin for Thromboprophylaxis in Trauma Patients Sustaining Lower Extremity Fractures

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