[Prophylaxis of venous thromboembolism in orthopaedic surgery--trivial option, huge potential].
Venous thromboembolism (VTE) is a common, sometimes even fatal though preventable complication after surgical interventions, especially in orthopaedic surgery. The risk can be reduced by more than 50 % by mechanical means and different anticoagulant drugs. However, only few patients receive adequate treatment. Medicamentous options are limited and somewhat difficult. Most anticoagulant substances act indirectly, therefore their efficacy can easily be impaired. For some, the pharmacokinetics are quite unfavourable. Furthermore, these drugs can cause severe adverse reactions; and since drug therapy either needs daily injections or routine blood checks, its acceptance is limited even further. Fortunately, new substances have reached phase III and will shortly be released. They have a broad therapeutic index, favourable pharmacodynamics and -kinetics and seem to cause only few adverse events. Rivaroxaban, for example, is approved for orthopaedic interventions like total hip or knee replacement. Orally administered, it interacts directly with factor Xa. It proved to be superior compared to the standard therapy with Enoxaparin, has a similar risk profile and needs no routine blood checks. The following article gives a critical survey of the problem, therapeutic options, current guidelines and new possibilities. Hopefully, these new simplified therapy options will increase the acceptance of VTE prophylaxis so that the rate of fatal complications after orthopaedic interventions can further be reduced.
Behandlungszentrum Bewegungsapparat, Universitätsspital Basel, Basel, Switzerland. saxerf@uhbs.ch
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D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001780:Blood Coagulation Tests; D003131:Combined Modality Therapy; D017277:Drug Approval; D004347:Drug Interactions; D004434:Early Ambulation; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D065427:Factor Xa Inhibitors; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D009025:Morpholines / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D019637:Orthopedic Procedures; D011182:Postoperative Care; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D000069552:Rivaroxaban; D053828:Stockings, Compression; D013876:Thiophenes / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000517:prevention & control*
D000925:Anticoagulants; D017984:Enoxaparin; D065427:Factor Xa Inhibitors; D009025:Morpholines; D013876:Thiophenes; D000069552:Rivaroxaban