The use of novel oral anticoagulants for thromboprophylaxis after elective major orthopedic surgery

Saleh Rachidi, Ehab Saad Aldin, Charles Greenberg, Barton Sachs, Michael Streiff, Amer M. Zeidan

Research output: Contribution to journalReview articlepeer-review

Abstract

Venous thromboembolism is a common cause of morbidity and mortality among patients undergoing elective orthopedic surgery. Due to the high incidence of venous thromboembolism in this setting, perioperative anticoagulation is the recommended approach for thromboprophylaxis. Low molecular weight heparin (LMWH), fondaparinux and warfarin are the agents commonly used for thromboprophylaxis. The well-recognized limitations of warfarin and the inconvenience and discomfort associated with the subcutaneous administration of low molecular weight heparin and fondaparinux inspired intense investigation to develop novel oral anticoagulants (NOACs) with more predictable pharmacokinetics, fewer drug interactions and no need for regular laboratory monitoring. Three NOACs have been demonstrated to be effective for thromboprophylaxis after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in large randomized controlled trials. Here we review the pharmacology of rivaroxaban, dabigatran, and apixaban, summarize the major clinical trials of these agents in thromboprophylaxis after THA and TKA, and discuss the clinical factors to be considered by providers when selecting a NOAC for their patients.

Original languageEnglish (US)
Pages (from-to)677-695
Number of pages19
JournalExpert Review of Hematology
Volume6
Issue number6
DOIs
StatePublished - 2013
Externally publishedYes

Keywords

  • Anticoagulants
  • Apixaban
  • Arthroplasty
  • Dabigatran
  • Hip
  • Knee
  • Orthopedic
  • Prophylaxis
  • Replacement
  • Rivaroxaban
  • Venous thromboembolism

ASJC Scopus subject areas

  • Hematology

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