title: Effects of thromboembolism prophylaxis with dabigatran on perioperative blood loss and wound secretion in primary hip arthroplasty.
abstract: BACKGROUND
  Low-molecular-weight heparins (LMWH), e.g. enoxaparin, represent the standard thromboprophylactic agents in Europe after total hip replacement. The oral direct thrombin inhibitor dabigatran etexilate provides comparable effectiveness and safety. The present study aimed to evaluate the influence of dabigatran etexilate on perioperative blood loss and wound secretion in total hip arthroplasty compared to enoxaparin.
  
  
  METHODS
  Patients receiving primary total hip replacement between January and June 2009 were included. The association between thromboembolism prophylaxis with dabigatran etexilate or enoxaparin and the perioperative blood loss was investigated. The effective blood loss (EBL) was calculated taking blood transfusions and the difference between preoperative haemoglobin and haemoglobin on the day of discharge into account. Additional comparison of wound secretion depending on thromboprophylactic agents was performed in a separate, prospectively collected patients' population. Statistical analysis was performed with χ<formula> ^{2}</formula>-Test, Student's t-test or Mann-Whitney U-test. Statistical significance was considered at p < 0.05.
  
  
  RESULTS
  198 patients (111 women, 87 men) with primary total hip arthroplasty were enrolled. Patients' mean age was 63.0 ± 11.9 years. Thromboembolism prophylaxis was performed in 111 patients (56.1%) with dabigatran etexilate, 87 patients (43.9%) received enoxaparin. No significant differences concerning EBL and wound secretion were found between both study groups. In the dabigatran etexilate group the EBL was 1.66 ± 0.56 l compared to 1.77 ± 0.65 l in patients with enoxaparin.
  
  
  CONCLUSIONS
  Dabigatran etexilate can safely be used for thromboembolism prophylaxis after primary total hip replacement without an increased risk for perioperative blood loss and prolonged wound secretion.
authors.affiliation: Trauma Department, Hannover Medical School (MHH), Hannover, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Mommsen
authors.affiliation: Department of Orthopaedic Joint Surgery and Endoprosthetics, ENDO-Clinic Hamburg, Hamburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Doering
authors.affiliation: Department of Anaesthesiology, ENDO-Clinic Hamburg, Hamburg, Germany.
authors.forename: Ehrenfried
authors.initials: E
authors.lastname: R O Hrs
authors.affiliation: Department of Orthopaedic Joint Surgery and Endoprosthetics, ENDO-Clinic Hamburg, Hamburg, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Egidy
authors.affiliation: Department of Orthopaedic Joint Surgery and Endoprosthetics, ENDO-Clinic Hamburg, Hamburg, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Gehrke
authors.affiliation: Trauma Department, Hannover Medical School (MHH), Hannover, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Krettek
authors.affiliation: Department of Orthopaedic Joint Surgery and Endoprosthetics, ENDO-Clinic Hamburg, Hamburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kendoff
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000009:adverse effects* / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D001562:Benzimidazoles / Q000009:adverse effects* / Q000627:therapeutic use; D001826:Body Fluids / Q000378:metabolism; D000069604:Dabigatran; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D013923:Thromboembolism / Q000517:prevention & control*; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000991:Antithrombins; D001562:Benzimidazoles; D015091:beta-Alanine; D000069604:Dabigatran
keywords: Hip arthroplasty; blood loss; dabigatran etexilate; enoxaparin; thromboembolism prophylaxis; wound secretion