DO WE KNOW ALL ABOUT PREVENTION OF VENOUS THROMBOEMBOLISM AFTER MAJOR ORTHOPEDIC SURGERY?

Development of a risk-oriented algorithm for the combined use of hemostatics and anticoagulants to prevent thrombosis and bleeding cases after total arthroplasty of knee or hip joints

Introduction: The goal of our study was to develop a risk-oriented algorithm for the combined use of hemostatics and anticoagulants in patients after total arthroplasty of the knee or hip joints to reduce the risk of thrombohemorrhagic complications.

Materials and methods: We performed a retrospective study (n=253). In group (Gr.) 1, the time interval (TI) between the administration of hemostatic and anticoagulant prophylaxis was ≤17 hours (n=145; 57.31%), and in Gr. 2 – 18-24 hours (n=108; 42.68%). We analyzed the influence of different factors on the development of thrombosis and bleeding cases after the operation.

Results and discussion: Thrombohemorrhagic complications were observed in 27 (10.67%) patients. Thrombosis in Gr. 1 was associated with the use of tranexamic acid, and were recorded 2.2 times more often than in Gr. 2 (p<0.05). The development of thrombosis in Gr. 1 was influenced by: class II obesity, type 2 diabetes mellitus, myocardial infarction, venous pathology, age of patients >75 years, for women – an initially low level of international normalized ratio, and activated partial thromboplastin time (APTT) (p<0.05). The development of bleeding in Gr. 1 was influenced by: age >75 years, among men and women – an increased preoperative level of APTT, for women – a decreased level of fibrinogen and platelets (p<0.05).

Conclusion: To prevent thrombosis and bleeding after arthroplasty of large joints, the TI between the use of hemostatics and anticoagulants should be at least 18 hours, especially in patients with the above risk factors, in particular, when using tranexamic acid and low molecular weight heparins.

[The use of parnaparin sodium (Fluxum) in the prevention of thromboembolic complications after surgical treatment of fractures associated with high risks of thrombosis]

The need for thromboprophylaxis in traumatological and orthopedic operations is determined by a constant increase in the level of injuries of the population, and as a result, fluctuating coagulation indicators. Risk factors inherent in modern society that correlate primarily with reduced physical activity and excessive consumption of unbalanced (carbohydrate) nutrition, bad habits (nicotinism, alcoholism and other toxic dependencies), increased life expectancy and comorbidity - these and other causes can lead to an increase in the incidence of vascular accidents in patients with large limb bone fractures. The goal is to compare the effectiveness and clinical safety of using parnaparin sodium (Fluxum) and enoxaparin sodium as the prevention of thrombosis in the treatment of lower limb bone fractures.

MATERIAL AND METHODS

A comparative assessment of the effectiveness and clinical safety of thrombosis prevention in the treatment of lower limb bone fractures using low-molecular weight heparins: parnaparin sodium (Fluxum) and enoxaparin sodium.

RESULTS

Taking into account the literature data on the significant risk of venous thromboembolic complications, we successfully conduct the thromboprophylaxis in patients with the traumatological and orthopedic profile, including in 2019 using the drug parnaparin sodium (Fluxum, «Alfasigma»). Our own comparative clinical experience has shown that with the convenience of taking enoxaparin sodium and the completeness of the scheme, the prevention of thrombosis with the use of parnaparin sodium shows the tendency to better clinical effectiveness and safety.

CONCLUSION

The choice of anticoagulants in traumatological and orthopedic practice, with obvious ease of use, provides the complete scheme for the prevention of thrombosis. Further research is needed on the routine use of sodium parnaparin in order to prevent thronbosis in the treatment of fractures of various localization.