Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty (original) (raw)
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Clinical Orthopaedics & Related Research, 2019
Background Although the use of thromboprophylaxis is well established, there is no consensus on the preferred thromboprophylaxis regimen after THA; large, population-based studies offer an opportunity to examine this problem in a robust way that can complement results from randomized trials. Questions/purposes Using data from a large national registry, we asked: (1) Is there any difference between low-molecular weight heparin (LMWH) and new oral anticoagulants in preventing symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE), after One of the authors certifies that he (OR) has received personal fees during the study period, in an amount of less than USD 10,000, from Zimmer Biomet (Winterthur, Switzerland) as reimbursement for presentation (Gothenburg, Sweden), outside the submitted work. One of the authors certifies that he (MM) has received personal fees during the study period, in an amount of less than USD 10,000, from Zimmer Biomet (Winterthur, Switzerland) as reimbursement for presentation (Copenhagen, Denmark); and grants as institutional support in an amount of less than 10,000 USD, from Link (Hamburg, Germany), all outside the submitted work. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This study was performed in Sweden as a nationwide study, based on national registries with continuous data collection from all performing centers in the country. The authors in their respective centers in Gothenburg and Stockholm, Sweden performed the analysis and writing.
PLOS ONE, 2021
Objective To search, review, and analyze the efficacy and safety of various anticoagulants from randomized clinical trials (RCTs) of anticoagulants for THA and TKA. Design PRISMA-compliant Bayesian Network Meta-analysis. Data sources and study selection The databases of The Medline, Embase, ClinicalTrial, and Cochrane Library databases were searched until March 2017 for RCTs of patients undergoing a THA or TKA. Main outcomes and measures The primary efficacy measurement was the venous thromboembolism Odds ratio (OR). The safety measurement was the odds ratio of major or clinically relevant bleeding. OR with 95% credibility intervals (95%CrIs) were calculated. Findings were interpreted as associations when the 95%CrIs excluded the null value. Results Thirty-five RCTs (53787 patients; mean age range, mostly 55–70 years; mean weight range, mostly 55–90 kg; and a higher mean proportion of women than men, around 60%) included the following Anticoagulants categories: fondaparinux, edoxaba...
International Journal of Cardiovascular Research, 2015
Background: In major orthopedic surgery, prevention of venous thromboembolism has been based on Unfractionated Heparins (UFHs) over the past decades, then on Low-Molecular Weight Heparins (LMWHs), and on New Oral Anticoagulants (NOACs) more recently. To summarize the comparative effectiveness of UFHs, LMWHs, and NOACs in this clinical indication, we applied Bayesian network meta-analysis to the clinical material (randomized studies) published in two previous reviews focused on this issue. Objectives: Our end-point was a composite of venous thromboembolism and pulmonary embolism. Materials and Methods: Our analysis was based on standard Bayesian network metaanalysis (random-effect model). Results: The analysis included 21 randomized trials for a total of 21,805 patients. Our results showed that the degree of effectiveness did not differ among UFHs, LMWHs, and NOACs. Although some trends emerged from an in-depth analysis of these data (e.g. according to the histogram of rankings), no significant differences were found (P > 0.05). Moreover, two agents among LMWHs proved to be adequately supported by randomized trials (enoxaparin and dalteparin), while limited evidence was available for other agents of this class. Conclusions: Our synthesis of the effectiveness data can be useful as an overall reference in this area and can also contribute to defining the place of further innovative treatments for this clinical indication.
2021
Background This a priori statistical analysis plan describes the analysis for CRISTAL. Methods CRISTAL (cluster-randomised, crossover, non-inferiority trial of aspirin compared to low molecular weight heparin for venous thromboembolism prophylaxis in hip or knee arthroplasty, a registry nested study) aims to determine whether aspirin is non-inferior to low molecular weight heparin (LMWH) in preventing symptomatic venous thromboembolism (VTE) following hip arthroplasty (HA) or knee arthroplasty (KA). The study is nested within the Australian Orthopaedic Association National Joint Replacement Registry. The trial was commenced in April 2019 and after an unplanned interim analysis, recruitment was stopped (December 2020), as the stopping rule was met for the primary outcome. The clusters comprised hospitals performing > 250 HA and/or KA procedures per annum, whereby all adults (> 18 years) undergoing HA or KA were recruited. Each hospital was randomised to commence with aspirin, o...
Arthroplasty
Background Guidelines support aspirin thromboprophylaxis for primary total hip and knee arthroplasty (THA and TKA) but supporting evidence has come from high volume centers and the practice remains controversial. Methods We studied 4562 Medicare patients who underwent elective primary THA (1736, 38.1%) or TKA (2826, 61.9%) at 9 diverse hospitals. Thirty-day claims data were combined with data from the health system’s electronic medical records to compare rates of venous thromboembolism (VTE) between patients who received prophylaxis with: (1) aspirin alone (47.3%), (2) a single, potent anticoagulant (29%), (3) antiplatelet agents other than aspirin or multiple anticoagulants (21.5%), or (4) low-dose subcutaneous unfractionated heparin or no anticoagulation (2.2%). Sub-analyses separately evaluating THA, TKA and cases from lower volume hospitals (n = 975) were performed. Results The 30-day VTE incidence was 0.6% (29/4562). VTE rates were equal in patients receiving aspirin and those ...
Meta-analysis of thromboembolic prophylaxis in total knee arthroplasty
The Journal of Arthroplasty, 1997
W e performed a meta-analysis of the English literature to assess the efficacy of four common regimes for thromboembolic prophylaxis after total knee arthroplasty: aspirin, warfarin, low-molecular-weight heparin (LMWH) and pneumatic compression. We reviewed 136 articles and abstracts published between January 1980 and December 1997. Papers not using routine venography and a lung scan or angiography to detect deep-venous thrombosis (DVT) and pulmonary emboli (PE) respectively, were excluded. Of the 136 studies, 23 with 6001 patients were selected.
Thromboembolic prophylaxis in total joint arthroplasty
Thrombosis, 2012
Approximately 775,000 hip and knee arthroplasties are performed yearly in the United States, with a dramatic increase expected. Patients having hip and knee arthroplasties are at high risk of developing a venous thromboembolism. The American College of Chest Physicians (ACCP) and the American Academy of Orthopedic Surgeons (AAOS) have updated guidelines, which outline new prophylactic strategies. Factor Xa inhibitor rivaroxaban has a new recommendation by ACCP and is gradually being adopted by the joint arthroplasty community as an effective oral agent. Other more well-known agents including warfarin, low-molecular-weight heparin, aspirin, and fondaparinux continue to be options for prophylaxis. While the goal of prophylaxis continues to be the prevention of venous thromboemboli and pulmonary emboli, it is important to consider the increased bleeding risk associated with their use. The most recent ACCP and AAOS guidelines give clinicians a greater autonomy in choosing a prophylactic...
BMJ Open, 2019
To cite: Sidhu VS, Graves SE, Buchbinder R, et al. CRISTAL: protocol for a cluster randomised, crossover, noninferiority trial of aspirin compared to low molecular weight heparin for venous thromboembolism prophylaxis in hip or knee arthroplasty, a registry nested study. BMJ Open 2019;9:e031657.