[Oral prevention of thromboembolism with rivaroxaban and dabigatran: are the newly approved drugs innovations in orthopaedic and trauma surgery? ].
Today the indication for thrombosis prophylaxis is a relevant and daily concern in orthopaedic surgery. Recently there are some changes concerning the German guidelines, which are approved by 27 German medical societies. For the first time the guidelines give distinct recommendations for the different indications, the kind of thrombosis prophylaxis and its duration. Some of the recommendations will lead to changes of both processes in outpatient and inpatient management. In parallel 2 new oral anticoagulants have been approved for the prevention of thromboembolic events after elective knee and hip replacement. Dabigatran is an oral thrombin inhibitor. Compared to enoxaparin it has a comparable profile of side effects and efficacy. Rivaroxaban is an oral Xa inhibitor which shows a significantly better efficacy compared to enoxaparin and no difference in side effects. The significant reduction of symptomatic thromboembolisms after elective knee and hip replacement was shown for rivaroxaban compared to enoxaparin in a pooled analysis of phase III data. This review discusses the main topics of the new German guideline and impact of the new oral anticoagulants on in- and outpatient treatment procedures.
Klinik für Wirbelsäulenchirurgie mit Skoliosezentrum, Am Kiebitzberg 10, Neustadt. mquante@schoen-kliniken.de
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D000284:Administration, Oral; D001562:Benzimidazoles / Q000008:administration & dosage*; D000069604:Dabigatran; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D009025:Morpholines / Q000008:administration & dosage*; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000592:standards; D009985:Orthopedics / Q000592:standards*; D017410:Practice Guidelines as Topic; D000069552:Rivaroxaban; D013876:Thiophenes / Q000008:administration & dosage*; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control*; D014194:Traumatology / Q000592:standards*; D016896:Treatment Outcome; D015091:beta-Alanine / Q000008:administration & dosage / Q000031:analogs & derivatives*
D001562:Benzimidazoles; D005343:Fibrinolytic Agents; D009025:Morpholines; D013876:Thiophenes; D015091:beta-Alanine; D000069552:Rivaroxaban; D000069604:Dabigatran