Thromboembolic complications and pharmacological prophylaxis in orthopaedic surgery

Montebugnoli, M.; Bugamelli, S.; Bonfatti, M.; Facchini, Fiorenzo; Pignotti, Elettra; Cenacchi, Annarita

doi:10.1111/j.1365-2044.1998.tb15157.x

Cited by 2 publications

(2 citation statements)

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“…For the venographic studies, two performed unilateral venography [13,17], one included less than 200 patients [9], and another study, published only as an abstract, did not report a breakdown of asymptomatic and symptomatic events [8]. For the symptomatic outcome studies, four studies did not report outcomes separately for patients treated with enoxaparin [25–28], while another study did not report outcomes separately for THR and TKR [29]. After excluding the aforementioned studies, 12 studies remained to be included in our review.…”

Section: Resultsmentioning

confidence: 99%

Association between asymptomatic deep vein thrombosis detected by venography and symptomatic venous thromboembolism in patients undergoing elective hip or knee surgery

Quinlan

Eikelboom

Dahl

et al. 2007

Journal of Thrombosis and Haemostasis

106

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Summary. Background: Venography is commonly used to compare the efficacy of different thromboprophylaxis strategies for preventing deep vein thrombosis (DVT) in patients undergoing total hip replacement (THR) or total knee replacement (TKR). Methods: We explored the relation between asymptomatic DVT and symptomatic venous thromboembolism (VTE) in patients undergoing THR or TKR treated with standard doses of enoxaparin (30 mg b.i.d. or 40 mg o.d.) by comparing the incidence of asymptomatic DVT in venographic studies with the incidence of symptomatic VTE in studies where venography was not performed. Results: In 10 venographic studies involving 5796 patients, the incidence of asymptomatic DVT after THR was 13.2% [95% CI, 12.2-14.2%] and after TKR was 38.1% (95% CI, 35.5-40.8%). In two studies involving 3500 patients who did not undergo venography, the 90-day incidence of symptomatic VTE after THR was 2.7% (95% CI, 2.1-3.4%) and after TKR was 1.8% (95% CI, 0.9-2.7%). For every symptomatic VTE in THR studies where venography was not performed there were five asymptomatic DVTs in the venographic studies; for TKR, the ratio was 1:21. The incidence of asymptomatic DVT and the symptomatic VTE/asymptomatic DVT ratio was influenced by the venogram reading committee (Gothenburg vs. Hamilton: total DVT after THR, 19.5% vs. 8.7%, P < 0.0001; for TKR, 42.7% vs. 27.2%, P < 0.0001). Conclusions: Comparisons across trials show a consistent relation between asymptomatic venographic DVT in patients undergoing elective THR or TKR surgery and symptomatic VTE in patients not undergoing venography. Differences exist in the strength of the relation depending on the type of surgery and the venogram reading committee.

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Section: Resultsmentioning

confidence: 99%

Association between asymptomatic deep vein thrombosis detected by venography and symptomatic venous thromboembolism in patients undergoing elective hip or knee surgery

Quinlan

Eikelboom

Dahl

et al. 2007

Journal of Thrombosis and Haemostasis

106

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“…In a clinical study comparing indobufen to heparin in patients who underwent major orthopaedic surgery both drugs could prevent postoperative complications. The indobufen-treated patients had a shorter hospital stay, though no significant differences between the groups regarding clinical parameters were observed [147]. Compared with pentoxifylline, indobufen could more effectively increase walking distance in patients suffering from peripheral arterial occlusive disease.…”

Section: Inhibitors Of Cox/prostaglandin H 2 Synthasementioning

confidence: 70%

Inhibitors of platelet signal transduction as anti-aggregatory drugs

Geiger

2001

Expert Opinion on Investigational Drugs

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In the treatment and prevention of cardiovascular diseases, inhibition of platelet aggregation is of fundamental importance. Inhibition of platelet aggregation can be achieved by either inhibition of membrane receptors or by interception of signalling pathways. While receptor antagonism provides high specificity, the inhibition of platelet signal transduction is more effective. The effectiveness results from the inhibition of platelets, regardless of the cause of activation. These common pathway inhibitors are either intercepting platelet activating mechanisms or amplifying the action of endogenous platelet inhibitors. The physiological anti-aggregants are the endothelial factors NO and prostacyclin, which elevate intracellular cGMP or cAMP content, respectively. By administration of NO-releasing agents, prostacyclin analogues or other cyclic nucleotide elevating drugs the platelet anti-aggregatory action of endothelial factors can be effectively mimicked. Besides antiplatelet activity these drugs also act on vascular smooth muscle causing relaxation and therefore vasodilation, an additional beneficial effect. Inhibition of phosphodiesterases causes elevation of platelet cyclic nucleotide content and thus inhibits platelet aggregation and causes vasodilation. Another relevant target for anti-aggregatory treatment is the arachidonic acid metabolic pathway. This pathway can be intercepted by blockade of either cyclooxygenase-1 (COX-1) or thromboxane synthase. Inhibition of these enzymes may be further amplified by additional antagonism of the thromboxane receptor thus not only preventing formation of thromboxane but also activation of thromboxane receptor by thromboxane precursors, which were particularly effective in clinical trials. In vivo these precursors may be metabolised to prostacyclin in the endothelium and consequently provide additional platelet anti-aggregatory activity. A rather new target for platelet anti-aggregatory treatment is the ecto-nucleotidase CD-39 which limits the plasma level of nucleotides. While several of the novel anti-aggregatory drugs were disappointing in clinical studies combinations of drugs with different effector enzymes showed potent antithrombotic efficacy.

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Thromboembolic complications and pharmacological prophylaxis in orthopaedic surgery

Cited by 2 publications

References 4 publications

Association between asymptomatic deep vein thrombosis detected by venography and symptomatic venous thromboembolism in patients undergoing elective hip or knee surgery

Association between asymptomatic deep vein thrombosis detected by venography and symptomatic venous thromboembolism in patients undergoing elective hip or knee surgery

Inhibitors of platelet signal transduction as anti-aggregatory drugs

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