Use of oral anticoagulants for the prevention of thromboembolic events in the post-operative period of hip arthroplasty: a systematic review

Trevisol, Anderson Reus; Coppi, Eduardo Felipe Mandarino; Pancotte, Julia; Bortoluzzi, Emanuelly Casal; Knop, Gabriel Pozzobon

doi:10.1016/j.rboe.2018.07.005

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Artigo de Revisão • Rev. bras. ortop. 53 (5) • Sep-Oct 2018 • https://doi.org/10.1016/j.rboe.2018.07.005 copy

Use of oral anticoagulants for the prevention of thromboembolic events in the post-operative period of hip arthroplasty: a systematic review^☆ ☆ Study conducted at Instituto de Ortopedia e Traumatologia (IOT), Passo Fundo, RS, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Oral anticoagulants are being used in the postoperative period of hip arthroplasty to prevent of thromboembolic events, create doubts as to the effectiveness of thromboprophylaxis and reduce the risk of hemorrhage. This systematic revision is aimed at evaluating the use of oral anticoagulants in the prevention of thromboembolic events in the postoperative period of patients undergoing hip arthroplasty. Research with descriptors found on PubMed, BVS, and the CAPES portal for medical journal publications from September 2015 to June 2016, from the last ten years (2005-2015), complete, free, and written in Portuguese and in English were the methods used. The results of the studies showed some cases of pulmonary embolism, deep vein thrombosis, and bleeding; even then, the NOACs were effective in preventing thromboembolic events. There is no consensus regarding the prophylaxis method for these events, which is why the challenge is to obtain high levels of prevention while minimizing the adverse effects. The most studied oral anticoagulant was rivaroxaban (67%). The three drugs that were studied have shown to be effective in preventing thromboembolic events, but the best results were obtained with rivaroxaban 10 mg, one tablet daily; treatment duration ranged from 30 to 35 days with oral anticoagulants and from 28 to 42 days with anti-platelet drugs.

Keywords:
Hip arthroplasty; Anticoagulants; Pulmonary embolism; Venous thrombosis/prevention & control

Author/year	Type of study	N	Oral anticoagulant/dosage	Time	Results
Eriksson et al., 2006¹⁰10 Eriksson BI, Borris LC, Dahl OE, Haas S, Huisman MV, Kakkar AK, et al. ODIXa-HIP Study Investigators. A once-daily, oral, direct Factor Xa inhibitor, rivaroxaban (BAY 59-7939), for thromboprophylaxis after total hip replacement. Circulation. 2006;114(22):2374-81.	Intervention	128 142 140 143 142	Rivaroxaban 5 mg Rivaroxaban 10 mg Rivaroxaban 20 mg Rivaroxaban 30 mg Rivaroxaban 40 mg	7 days	DVT 14.9%; major bleeding 2.3% DVT 10.6%; major bleeding 0.7% DVT 8.5%; major bleeding 4.3% DVT 13.5%; major bleeding 4.9% DVT 6.4%; major bleeding 5.1% Venous Doppler. No case of PE. Effective and safe in preventing PE/DVT.
Eriksson et al., 2008¹¹11 Eriksson BI, Borris LC, Friedman RJ, Haas S, Huisman MV, Kakkar AK, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med. 2008;358(26):2765-75.	Intervention	2209	Rivaroxaban 10 mg	35 days	Major bleeding: 6 (0.3%) cases. Minor bleeding: 128 (2.1%) cases. PE: 4 (0.3%) cases. Deep venous thromboembolism: 4 (0.2%) DVT: 12 (0.8%) cases. Low incidence of thrombosis and safe to use in thromboprophylaxis.
Kanan et al., 2008¹²12 Kanan PS, Schwartsmann CR, Boschin LC, Conrad S, Silva MF. Estudo comparative entre rivaroxaban e enoxaparina na profilaxia de tromboembolismo venoso profundo em pacientes submetidos à artroplastia total do quadril. Rev Bras Ortop. 2008;43(8):319-28.	Intervention	33	Rivaroxaban 10 mg	32–36 days	3 cases of DVT (phlebography 32–36 PO). No cases of PE or major bleeding. Effective.
Anderson et al., 2013¹³13 Anderson DR, Dunbar MJ, Bohm ER, Belzile E, Kahn SR, Zukor D, et al. Aspirin versus low-molecular-weight heparin for extended venous thromboembolism prophylaxis after total hip arthroplasty: a randomized trial. Ann Intern Med. 2013;158(11):800-6.	Intervention	380	Aspirin^® 81 mg	28 days	Proximal DVT 1 (0.3%) case. Major bleeding: 8 (2.1%) cases. No cases of PE. No cases of major bleeding. Effective and safe in prolonged thromboprophylaxis after THA.
Ozler et al., 2015¹⁴14 Özler T, Uluçay Ç, Önal A, Altıntaş F. Comparison of switch-therapy modalities (enoxaparin to rivaroxaban/dabigatran) and enoxaparin monotherapy after hip and knee replacement. Acta Orthop Traumatol Turc. 2015;49(3):255-9.	Intervention	60 60	Rivaroxaban 10 mg Dabigatran 220 mg	30 days 30 days	Minor bleeding: 3 patients (5%). Major bleeding: 1 patient (1.6%); minor bleeding: 2 patients (3.3%). Absence of DVT (Doppler).
Clave et al., 2012¹⁵15 Clavé A, Fazilleau F, Dumser D, Lacroix J. Efficacy of tranexamic acid on blood loss after primary cementless total hip replacement with rivaroxaban thromboprophylaxis: a case-control study in 70 patients. Orthop Traumatol Surg Res. 2012;98(5):484-90.	Observational	70	Rivaroxaban 10 mg	30 days	Absence of thromboembolic complications (at hospital discharge and 3 months after). 4 patients transfused.
Jobski et al., 2014¹⁶16 Jobski K, Enders D, Amann U, Suzart K, Wallander MA, Schink T, et al. Use of rivaroxaban in Germany: a database drug utilization study of a drug started in hospital. Eur J Clin Pharmacol. 2014;70(8):975-81.	Observational	206	Rivaroxaban 10 mg	35 days	TEV 1%.
Turpie et al., 2014¹⁷17 Turpie AG, Haas S, Kreutz R, Mantovani LG, Pattanayak CW, Holberg G, et al. A non-interventional comparison of rivaroxaban with standard of care for thromboprophylaxis after major orthopaedic surgery in 17,701 patients with propensity score adjustment. Thromb Haemost. 2014;111(1):94-102.	Observational	8778	Rivaroxaban 10 mg	33 days	Thromboembolic events: 0.89%. Major bleeding: 0.4%. Effective and safe in preventing PE/DVT.
Cossetto et al., 2012¹⁸18 Cossetto DJ, Goudar A, Parkinson K. Safety of peri-operative low-dose aspirin as a part of multimodal venous thromboembolic prophylaxis for total knee and hip arthroplasty. J Orthop Surg (Hong Kong). 2012;20(3):341-3.	Observational	50	Aspirin^® 100 mg	42 days	DVT: 3 patients (USG - 5 PO). No cases of PE.
Vulcano et al., 2012¹⁹19 Vulcano E, Gesell M, Esposito A, Ma Y, Memtsoudis SG, Gonzalez Della Valle A. Aspirin for elective hip and knee arthroplasty: a multimodal thromboprophylaxis protocol. Int Orthop. 2012;36(10):1995-2002.	Observational	887	Aspirin^® 325 mg (2×/daily)	45 days	Thromboembolic events: 18.8 (1.2%), PE: 5.6 (0.36%), pDVT: 7.0 (0.45%), dDVT: 5.6 (0.36%). Major bleeding: 5 (0.3%).
Bonarelli et al., 2015²⁰20 Bonarelli S, Bacchin MR, Frugiuele I, Feoli MA, Facchini F, Altimari V. Dabigatran etexilate and LMWH for the prevention of venous thromboembolism in 532 patients undergoing hip surgery. Eur Rev Med Pharmacol Sci. 2015;19(5):897-903.	Observational	211	Dabigatran 220 mg	35 days	Absence of symptomatic DVT or EP.

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] *Corresponding author. E-mail: jupancotte@hotmail.com (J. Pancotte).

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Use of oral anticoagulants for the prevention of thromboembolic events in the post-operative period of hip arthroplasty: a systematic review☆ ☆ Study conducted at Instituto de Ortopedia e Traumatologia (IOT), Passo Fundo, RS, Brazil.

ABSTRACT

Use of oral anticoagulants for the prevention of thromboembolic events in the post-operative period of hip arthroplasty: a systematic review^☆ ☆ Study conducted at Instituto de Ortopedia e Traumatologia (IOT), Passo Fundo, RS, Brazil.