title: Thrombophylaxis with low-dose, short-term fondaparinux after elective hip surgery.
abstract: Some studies have cautioned about the possibility of bleeding complications with routine use of anticoagulants like fondaparinux (FPX) for thrombophylaxis after elective hip surgery. Overdosing or prolonged periods of anticoagulant use should be avoided. We trialed a new regimen using FPX and tranexamic acid (TA) to reduce the risk of bleeding complications while maintaining efficacy in preventing deep vein thrombosis (DVT). The present study evaluated the effectiveness and safety of this regimen in 391 consecutive patients. Each patient was assigned either the FPX group, administered a once-daily subcutaneous injection of 1.5 mg of FPX on postoperative days 2, 3, and 4; or the intermittent pneumatic compression (IPC) group, which used an IPC device continuously for 1-2 days with no administration of any anticoagulant drugs. Ultrasonography was performed to diagnose DVT in all patients. No cases of fatal or symptomatic pulmonary embolism were encountered in either group, but six patients (3.1 %) in the FPX group and nine patients (6.0 %) in the IPC group showed asymptomatic distal DVT. The incidence of DVT tended to be lower (p = 0.19), volumes of intraoperative (p < 0.01) and postoperative (p < 0.01) blood loss were significantly smaller, and hemoglobin level was significantly higher in the FPX group than in the IPC group (p < 0.01). Our new thrombophylactic regimen using FPX and TA appears effective and safe for use after elective hip surgery.
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, Japan. kosuke-t@umin.net.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Tsuda
authors.affiliation: Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishii
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakai
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Takao
authors.affiliation: Center of Arthroplasty, Kyowakai Hospital, 1-24-1 Kishibe-kita, Suita, Osaka, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Nakamura
authors.affiliation: Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, Japan.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Sugano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D000077425:Fondaparinux; D006801:Humans; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D011134:Polysaccharides; D000077425:Fondaparinux
keywords: Deep venous thrombosis; Fondaparinux; Intermittent pneumatic compression device; Total hip arthroplasty; Tranexamic acid