Very low dose warfarin as prophylaxis against ultrasound detected deep vein thrombosis following primary hip replacement

Bern, Murray M.; Bierbaum, Benjamin E.; Wetzner, Steven M.; Brennan, William J.; McAlister, Sheila

doi:10.1002/ajh.10171

Cited by 9 publications

(2 citation statements)

References 47 publications

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“…As in our previous orthopedic studies and as with other investigators we selected a preoperative lead-time of 7 days for the fixed low dose warfarin used in this study [ 8 , 11 , 36 , 37 ]. In an earlier central venous catheter study we choose 3 days [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…Among these studies was a prospective pilot study of 100 patients in which patients planning total hip replacement were randomized between two arms, one with warfarin starting with 5.0 mg the night prior to surgery followed by variable dose warfarin (target PT 1.3–1.5 x normal) and the other using 1.0 mg of warfarin beginning seven days prior to surgery, and both continuing for 30–45 days. There was no difference for incidence of venous thrombosis [ 8 ]. Another was a retrospective study of patients undergoing primary ( n = 833) or revision ( n = 170) hip replacement arthroplasty who received 1.0 mg of warfarin for seven days prior to surgery, variable dose warfarin while in hospital (target INR 1.5–2.0) followed by1.0 mg daily until follow-up at 30–45 days.…”

Section: Introductionmentioning

confidence: 99%

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Low dose compared to variable dose Warfarin and to Fondaparinux as prophylaxis for thromboembolism after elective hip or knee replacement surgery; a randomized, prospective study

et al. 2015

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BackgroundDeep vein thrombosis (DVT) and pulmonary emboli (PE), known together as venous thromboembolic (VTE) disease remain major complications following elective hip and knee surgery. This study compares three chemoprophylactic regimens for VTE following elective primary unilateral hip or knee replacement, one of which was designed to minimize risk of post-operative bleeding.MethodsPatients were randomized and stratified for hip vs. knee to receive A: variable dose warfarin (first dose on the night preceding surgery with subsequent target INR 2.0–2.5), B: 2.5 mg fondaparinux daily starting 6–18 h postoperatively, or C: fixed 1.0 mg dose warfarin daily starting 7 days preoperatively. All treatments continued until bilateral leg venous ultrasound day 28 ± 2 or earlier upon a VTE event. The study examined primary endpoints including leg DVT, PE or death due to VTE and secondary endpoints including effects on D-dimer, estimated blood loss (EBL) at surgery and hemorrhagic complications.ResultsThree hundred fifty-five patients were randomized. None was lost to follow-up. Taking 1.0 mg warfarin for seven days preoperatively did not prolong the prothrombin time (PT). Two patients in Arm C had asymptomatic distal DVT. One major bleed occurred in Arm B and one in Arm C (ischemic colitis). Elevated d-dimer did not predict delayed VTE for one year.ConclusionsFixed low dose warfarin started preoperatively is equivalent to two other standards of care under study (95 % CI: -0.0428, 0.0067 for both) as VTE prophylaxis for the patients having elective major joint replacement surgery.Trial registrationClinicalTrials.gov identifier # NCT00767559FDA IND: 103,716

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Low dose compared to variable dose Warfarin and to Fondaparinux as prophylaxis for thromboembolism after elective hip or knee replacement surgery; a randomized, prospective study

et al. 2015

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Warfarin und Natriumwarfarin [MAK Value Documentation in German language, 2011]

2012

The MAK‐Collection for Occupational Health and Safety

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Veröffentlicht in der Reihe Gesundheitsschädliche Arbeitsstoffe , 51. Lieferung, Ausgabe 2011 Der Artikel enthält folgende Kapitel: Allgemeiner Wirkungscharakter Wirkungsmechanismus Toxikokinetik und Metabolismus Aufnahme, Verteilung, Ausscheidung Metabolismus Erfahrungen beim Menschen Einmalige Exposition Wiederholte Exposition Wirkung auf Haut und Schleimhäute Allergene Wirkung Reproduktionstoxizität Genotoxizität Kanzerogenität Tierexperimentelle Befunde und In‐vitro‐Untersuchungen Akute Toxizität Subakute, subchronische und chronische Toxizität Wirkung auf Haut und Schleimhäute Allergene Wirkung Reproduktionstoxizität Genotoxizität Kanzerogenität Bewertung

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