title: Pharmacological thromboprophylaxis and total hip or knee replacement.
abstract: Pharmacological and mechanical thromboprophylaxis reduces the risk of venous thromboembolism (VTE) in patients undergoing total knee/hip replacement (TKR/THR). Nurses play a key role in VTE prevention through clinical care, before and after discharge from hospital, and patient education. Conventional pharmacological agents for VTE prophylaxis include low molecular weight heparins (LMWHs) and fondaparinux. However, parenteral administration, increased bleeding risk, and patient/physician non-adherence to treatment and guidelines, are important limitations. Three non-vitamin K antagonist oral anticoagulants--dabigatran etexilate, rivaroxaban and apixaban--are available in the UK for VTE prevention following THR/TKR. In common with LMWHs and fondaparinux, these offer rapid onset of action and fixed doses without the need for routine coagulation monitoring. An agent for emergency reversal of dabigatran is in development, while there is no antidote for fondaparinux and LMWHs can be partially neutralised by protamine. Oral administration may result in better adherence to treatment and guidelines, reducing the nurse burden after discharge, and enhancing cost-effectiveness.
authors.affiliation: Professor of Orthopaedics, Musculoskeletal Science Research Group, Institute of Translational Medicine, University of Liverpool.
authors.forename: Simon
authors.initials: S
authors.lastname: Frostick
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D058128:Compression Bandages; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D011183:Postoperative Complications / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulants; Orthopaedic surgery; Total hip replacement; Total knee replacement; Venous thromboembolism