Guidelines for venous thromboembolism (VTE) prevention in the surgical patient have
been published by the American College of Chest Physicians (ACCP), the American College
of Physicians, the American Academy of Orthopaedic Surgery, and the International
Society of Angiology [
1
,
2
,
3
]. The ongoing challenge is to balance the risk of bleeding versus the benefit of VTE
prevention because studies have suggested that there is an increased bleeding risk
associated with more effective pharmacologic prophylaxis. The purpose of this article
is to review the cause and risk factors for VTE as well as to discuss the methods
of prophylaxis for various procedures as recommended by the guidelines. The article
concludes with a more detailed overview of the pharmacology and clinical trial results
of the new oral anticoagulants that have already been approved in Europe and Canada
for VTE prevention in the orthopedic patient population.To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Advances in SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevention of venous thromboembolism.Chest. 2008; 133: S381-S453
- Prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty.J Am Acad Orthop Surg. 2009; 17: 183-196
- Prevention and treatment of venous thromboembolism. International consensus statement (guidelines according to scientific evidence).International Angiology. 2006; 25: 101-161
- Soleal sinuses and stasis.Br J Surg. 1970; 57: 307
- Influence of anesthesia on blood flow to the calves during surgery.Acta Anaesthesiol Scand. 1984; 28: 201-203
- Blood flow in the calves during surgery.Acta Chir Scand. 1977; 143: 335-339
- Pathology and pathogenesis of deep vein thrombosis.in: Bergan J. Yao J. Venous problems. Year Book, Chicago1976: 257-269
- Products of tissue injury: their induction of venous endothelial damage and blood cell adhesion in the dog.Arch Pathol Lab Med. 1980; 104: 409-413
- Total hip replacement induces injury to remote veins in a canine model.J Bone Joint Surg Am. 1983; 65: 97-102
- Operative venodilation: a previously unsuspected factor in the cause of postoperative deep vein thrombosis.Surgery. 1989; 106: 301-309
- The Po2 in venous valve pockets: its possible bearing on thrombogenesis.Br J Surg. 1981; 68: 166-170
- The aetiology of deep venous thrombosis.QJM. 2006; 99: 581-593
- The postoperative fibrinolytic shutdown: a rapidly reverting acute phase pattern for the fast acting inhibitor of tissue-type plasminogen activator after trauma.Scand J Clin Lab Invest. 1985; 45: 605-610
- Fibrinolytic shut down after surgery: impairment of the balance between tissue-type plasminogen activator and its specific inhibitor.Eur J Clin Invest. 1985; 15: 308-312
- The effect of total hip replacement and general surgery on antithrombotin III in relation to venous thrombosis.J Bone Joint Surg Am. 1979; 61: 653-656
- The heparin antithrombin system: a natural anticoagulant mechanism.in: Colman R. Hirsh J. Marder V. Hemostasis and thrombosis: basic principles of clinical practice. 2nd edition. JB Lippincott, Philadelphia1987: 1373
- Thrombosis after hip replacement: relationship to the fibrinolytic system.Acta Orthop Scand. 1989; 60: 159-163
- Risk assessment as a guide for the prevention of the many faces of venous thromboembolism.Am J Surg. 2010; 199: S3-S10
- A valid study of a retrospective venous thromboembolism risk scoring method.Ann Surg. 2010; 2: 344-350
- Prevention of fatal postoperative pulmonary embolism by low doses of heparin: an international multicenter trial.Lancet. 1975; 2: 45-51
- Prevention of venous thromboembolism in general surgical patients: results of meta-analysis.Ann Surg. 1988; 208: 227-239
- Prevention of venous thromboembolism: the Seventh ACCP conference on antithrombotic and thrombolytic therapy.Chest. 2004; 126: 338S-400S
- The relationship between the hemorrhagic and antithrombotic properties of low molecular weight heparins and heparin.Blood. 1982; 59: 1239
- Low molecular weight heparin.Blood. 1992; 79: 1-17
- Prevention of postoperative deep vein thrombosis in general surgery: a multicenter double-blind study comparing two doses of Logiparin and standard heparin.Br J Surg. 1991; 78: 412
- Low molecular weight heparin versus standard heparin in general and orthopedic surgery: a meta-analysis.Lancet. 1992; 340: 152-156
- Prevention of venous thromboembolism in orthopedic surgery with vitamin K antagonists: a meta analysis.J Thromb Haemost. 2004; 2: 1058-1070
- Role of compression modalities in a prophylactic program for deep vein thrombosis.Semin Thromb Hemost. 1988; 14: 77-87
- Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture surgery: a multi-center, randomized, placebo-controlled, double-blind study.Arch Intern Med. 2003; 163: 1337-1342
- A comparison of intermittent pneumatic compression of the calf and whole leg in preventing deep venous thrombosis in urologic surgery.J Urol. 1997; 157: 1774-1776
- Low molecular weight heparin and compression stockings in the prevention of venous thromboembolism in neurosurgery.Thromb Haemost. 1996; 75: 233-238
- Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery.N Engl J Med. 1998; 339: 80-85
- Low rate of venous thromboembolism after craniotomy for brain tumor using multimodality prophylaxis.Chest. 2002; 122: 1933-1937
- Prevention of venous thromboembolism in neurosurgery: a metaanalysis.Chest. 2008; 134: 237-249
- Anticoagulant and aspirin prophylaxis for preventing thromboembolism after major gynecological surgery.Cochrane Database Syst Rev. 2003; (CD003679)
- ENOXACAN Study Group. Efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery: a double blind randomized multicenter trial with venographic assessment.Br J Surg. 1997; 84: 1099-1103
- Comparison of enoxaparin and standard heparin in gynecologic oncologic surgery: a randomized prospective double blind clinical study.Eur J Gynaecol Oncol. 2001; 22: 127-130
- Low dose heparin versus low molecular weight heparin (Fragmin) in the prophylaxis of thromboembolic complications of abdominal oncological surgery.Eur J Clin Invest. 1988; 18: 561-567
- Comparison of unfractionated versus low molecular weight heparin for deep vein thrombosis prophylaxis during breast and pelvic cancer surgery: efficacy, safety, and follow up.Clin Appl Thromb Hemost. 1998; 4: 268-273
- Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer.N Engl J Med. 2002; 346: 975-980
- Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin: overview of results of randomized trials in general, orthopedic, and urologic surgery.N Engl J Med. 1988; 318: 1162-1173
- Meta-analysis of low molecular weight heparin in the prevention of venous thromboembolism in general surgery.Br J Surg. 2001; 88: 913-930
- Randomized clinical trial of postoperative fondaparinux versus perioperative dalteparin for prevention of venous thromboembolism in high risk abdominal surgery.Br J Surg. 2005; 92: 1212-1220
- Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized open label study.J Thromb Haemost. 2006; 4: 2384-2390
- Risk of deep venous thrombosis after hospital discharge in patients having undergone total hip replacement: double-blind randomized comparison of enoxaparin versus placebo.Lancet. 1996; 348: 224-228
- Low molecular weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement.N Engl J Med. 1996; 335: 696-700
- Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomized trials.Lancet. 2001; 358: 9-15
- Short duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of prospective studies investigating symptomatic outcomes.Arch Intern Med. 2002; 162: 1465-1471
- Extended thromboprophylaxis with low molecular weight heparin reduces symptomatic venous thromboembolism following lower limb arthroplasty: a meta-analysis.Thromb Haemost. 2001; 85: 940-941
- Apixaban metabolism and pharmacokinetics after oral administration to humans.Drug Metab Dispos. 2009; 37: 74-81
- Apixaban, an oral direct factor Xa inhibitor, inhibits human clot-bound factor Xa activity in vitro.Thromb Haemost. 2009; 101: 780-782
- Inhibition of measured thrombin generation in human plasma by Apixaban: a predictive mathematical model based on experimentally determined rate constants.J Thromb Haemost. 2007; 5: PT633
- Apixaban, an oral direct factor Xa inhibitor: multiple-dose safety, pharmacokinetics and pharmacodynamics in healthy subjects.J Thromb Haemost. 2007; 5: P-M-664
- Apixaban or enoxaparin for thromboprophylaxis after knee replacement.N Engl J Med. 2009; 361: 594-604
- Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial.Lancet. 2010; 375: 807-815
- Apixaban versus enoxaparin for thromboprophylaxis after hip replacement.N Engl J Med. 2010; 363: 2487-2498
- Safety, pharmacodynamics, and pharmacokinetics of BAY 59-7939: an oral, direct Factor Xa inhibitor after multiple dosing in healthy male subjects.Eur J Clin Pharmacol. 2005; 61: 873-880
- Safety, pharmacodynamics, and pharmacokinetics of single doses of BAY 59-7939, an oral, direct Factor Xa inhibitor.Clin Pharmacol Ther. 2005; 78: 412-421
- In vitro and in vivo studies of the novel antithrombotic agent BAY 59-7939, an oral, direct Factor Xa inhibitor.J Thromb Haemost. 2005; 3: 514-521
- Metabolism and excretion of rivaroxaban, an oral, direct Factor Xa inhibitor, in rats, dogs, and humans.Drug Metab Dispos. 2009; 37: 1056-1064
- Comparative efficacy and safety of the novel oral anticoagulants dabigatran, rivaroxaban and apixaban in preclinical and clinical development.Thromb Haemost. 2010; 103: 572-585
- Effects of food, an antacid, and the H2 antagonist ranitidine on the absorption of BAY 59-7939 (rivaroxaban), an oral direct Factor Xa inhibitor, in healthy subjects.J Clin Pharmacol. 2006; 46: 549-558
- 59-7939: an oral, direct factor Xa inhibitor for the prevention of venous thromboembolism in patients after total knee replacement: a phase II dose-ranging study.J Thromb Haemost. 2005; 3: 2479-2486
- A once-daily, oral, direct factor Xa inhibitor, rivaroxaban (BAY 59-7939), for thromboprophylaxis after total hip replacement.Circulation. 2006; 114: 2374-2381
- Oral, direct factor Xa inhibition with BAY 59-7939 for the prevention of venous thromboembolism after total hip replacement.J Thromb Haemost. 2006; 4: 121-128
- Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty.N Engl J Med. 2008; 358: 2765-2775
- Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty.N Engl J Med. 2008; 358: 2776-2786
- Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial.Lancet. 2008; 372: 31-39
- Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial.Lancet. 2009; 373: 1673-1680
- The pharmacokinetics, pharmacodynamics and tolerability of dabigatran etexilate, a new oral direct thrombin inhibitor, in healthy male subjects.Br J Clin Pharmacol. 2007; 64: 292-303
- Pharmacokinetics and pharmacodynamics of the direct oral thrombin inhibitor dabigatran in healthy elderly subjects.Clin Pharm. 2008; 47: 47-59
- European public assessment report: pradaxa.(Available at:) (Accessed December 5, 2010)
- Pharmacokinetic profile of the oral direct thrombin inhibitor dabigatran etexilate in healthy volunteers and patients undergoing total hip replacement.J Clin Pharmacol. 2005; 45: 555-563
- Coadministration of dabigatran etexilate and atorvastatin: assessment of potential impact on pharmacokinetics and pharmacodynamics.Am J Cardiovasc Drugs. 2009; 9: 59-68
- Coadministration of the oral direct thrombin inhibitor dabigatran etexilate and diclofenac has little impact on the pharmacokinetics of either drug (abstract) XXIst Congress of the International Society of Thrombosis and Haemostasis 2007; P-T-677.(Available at:) (Accessed June 19, 2011)
- No interaction of the oral direct thrombin inhibitor dabigatran etexilate and digoxin (abstract) XXI st Congress of the International Society of Thrombosis and Haemostasis 2007;P-W-672.(Available at:) (Accessed June 19, 2011)
- Dabigatran etexilate: a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity.Thromb Haemost. 2010; 103: 1116-1127
- Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial.J Thromb Haemost. 2007; 5: 2178-2185
- Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, non-inferiority trial.Lancet. 2007; 370: 949-956
- Oral thrombin inhibitor dabigatran etexilate vs North American enoxaparin regimen for prevention of venous thromboembolism after knee arthroplasty surgery.J Arthroplasty. 2009; 24: 1-9
- Oral dabigatran versus enoxaparin for thromboprophylaxis after primary total hip arthroplasty (RE-NOVATE II).Thromb Haemost. 2011; 105: 721-729
Article info
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
