title: Novel oral anticoagulants for thromboprophylaxis after orthopaedic surgery.
abstract: The direct thrombin inhibitor, dabigatran, and the selective factor Xa inhibitors, rivaroxaban and apixaban, are new oral anticoagulants that are approved in many countries for prevention of venous thromboembolism in patients undergoing elective hip or knee arthroplasty. All have a rapid onset of action, a low potential for food and drug interactions and a predictable anticoagulant effect that obviates the need for routine coagulation monitoring. These agents offer a convenient alternative to conventional anticoagulant drug regimens, including parenteral low-molecular-weight heparins and fondaparinux, and oral adjusted-dose vitamin K antagonists, for the prevention of venous thromboembolism in this surgical setting. This review summarizes the pharmacology, clinical trial results, bleeding risk and practical use of these new oral anticoagulants in clinical orthopaedic practice. Potential issues to be considered when using these oral anticoagulants include renal impairment, potential drug interactions, neuraxial anaesthesia and management of bleeding.
authors: Department of Radiology, Kings College Hospital, London, United Kingdom.
authors: Daniel J
authors: DJ
authors: Quinlan
authors: Bengt I
authors: BI
authors: Eriksson
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000493:pharmacokinetics / Q000627:therapeutic use*; D019643:Arthroplasty, Replacement / Q000009:adverse effects; D001562:Benzimidazoles / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000069604:Dabigatran; D004334:Drug Administration Schedule; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D009025:Morpholines / Q000493:pharmacokinetics / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000473:pathology / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D011720:Pyrazoles / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011728:Pyridones / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D000069552:Rivaroxaban; D013876:Thiophenes / Q000493:pharmacokinetics / Q000627:therapeutic use*; D054556:Venous Thromboembolism / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D014859:Warfarin / Q000627:therapeutic use; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D006495:Heparin, Low-Molecular-Weight; D009025:Morpholines; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: anticoagulant; apixaban; dabigatran; deep vein thrombosis; pulmonary embolism; rivaroxaban; thromboprophylaxis; total hip arthroplasty; total knee arthroplasty