阿哌沙班vs依诺肝素用于膝关节置换术后血栓预防：随机双盲试验

全膝关节置换术（TKR）等骨科大手术后潜在危及生命的静脉血栓栓塞症,理想的血栓预防药物应降低术后血栓栓塞发生率且不增加出血和其他并发症。新型口服抗凝药物阿哌沙班是一种强效的直接xa因子抑制剂。ADVANCE-2研究在TKR患者中比较了阿哌沙班和依诺肝素预防术后静脉血栓栓塞症的疗效和安全性。这一研究主要疗效结果的优效性分析显示,     

阿哌沙班与依诺肝素预防髋关节置换术后血栓的比较：ADVANCE．3研究

Michael Rud Lassen, Alexander Gallus, Gary E. Raskob, et all [原著]接受髋关节置换术（totalhipreplacement,THR）的患者需要有效的血栓预防。低分子量肝素（10wmolecularweightheparirt,LMWH）、维生素K拮抗剂（vitaminKantagonist,VKA）和机械方法是在临床实践中广为应用的血栓预防方法,但是这些方法在实用上有一定局限性。新型口服抗凝药物（如xa因子抑制剂）为血栓预防带来了新的希望,其有效性和安全性与传统药物相似或更优,同时应用更为方便。阿哌沙班是一种高度特异性新型xa因子抑制剂。     

全膝关节置换术后下肢深静脉血栓的预防

目的 介绍全膝关节置换术后下肢深静脉血栓的预防经验。方法 对44例(56膝)全膝关节置换术后病人采用低分子量肝素 足底和下肢静脉泵，并行早期活动和功能锻炼等综合措施预防下肢深静脉血栓。结果 44例中，2例术后发生腓肠肌静脉丛内血栓，未见股静脉血栓。无一例发生肺栓塞死亡。结论 低分子量肝素结合足底和下肢静脉泵法是预防关节置换术后下肢深静脉血栓的有效方法。     

阿哌沙班与低分子肝素预防老年髋关节置换术后下肢深静脉血栓形成的有效性及安全性比较

目的 对全髋关节置换或翻修术后患者分别采用阿哌沙班和低分子肝素进行规范抗凝治疗,对比分析这两种药物预防下肢深静脉血栓形成的有效性和安全性.方法 纳入自2019-10-2019-12完成的50例全髋关节置换术或全髋关节翻修术,观察组25例术后采用阿哌沙班进行抗凝治疗,对照组25例采用低分子肝素进行抗凝治疗.比较观察组与对...     

达比加群酯、利伐沙班或阿哌沙班与依诺肝素用于全髋关节或膝关节置换术后的血栓预防：系统综述、荟萃分析和间接治疗比较

目的 分析新型口服抗凝药预防全髋或全膝关节置换术后静脉血栓栓塞的临床转归.设计系统综述、荟萃分析以及间接治疗比较.数据来源 Medline和CENTRAL（至2011年4月为止）、临床试验注册中心、会议论文集以及药品监管机构的网站.研究选择利伐沙班、达比加群酯或阿哌沙班与依诺肝素相比,预防全髋或全膝关节置换术后静脉血栓栓塞症的随机对照试验.由两名研究者独立提取数据.采用随机效应荟萃分析估计症状性静脉血栓栓塞、临床相关出血、死亡和净临床终点（症状性静脉血栓栓塞、严重出血和死亡的复合转归）的相对危险度.分别使用RevMan和ITC软件进行直接和间接比较.结果 共纳入16项试验,共计38 747例患者.与依诺肝素组相比,利伐沙班组（RR：0.48;95%CI：0.31～0.75）和阿哌沙班组（RR：0.82;95%CI：0.41～1.64）的症状性静脉血栓栓塞发生风险较低,达比加群酯组（RR：0.71;95%CI：0.23～2.12）.与依诺肝素组相比,利伐沙班组的临床相关出血相对危险度较高（RR：1.25;95%CI：1.05～1.49）,达比加群酯组与依诺肝素组相似（RR：1.12;95%CI：0.94～1.35）,而阿哌沙班组的相对危险度则较低（RR：0.82;95%CI：0.69～0.98）.直接和间接比较的结果显示,各种治疗的净临床终点均无差异.结论新型口服抗凝药的有效性较高,同时普遍有较高的出血倾向.新型口服抗凝药之间的有效性和安全性无显著差异.     

麻醉方式与全膝关节置换术后深静脉血栓形成及预防

下肢的骨关节手术常常并发深静脉血栓（deep vein thrombosis,DVT）形成,导致疼痛、静脉炎及肺栓塞,甚至危及生命。近年来骨科手术后深静脉血栓的发生率不断上升,其中人工全膝关节置换术（total knee arthroplosty,TKA）后DVT的发生倍受人们重视。     

速避凝预防全髋置换术后深静脉血栓

全髋置换术后静脉血栓发生率可达40％～70％，并有2％可发生严重的肺栓塞。为了解全髋置换术后深静脉血栓的发生率及速避凝对深静脉血栓的预防作用。1998年3月—2000年9月对121例全髋置换术后患者进行临床对照研究。     

追踪方法学用于预防人工髋关节置换术后深静脉血栓

目的探讨追踪方法学用于预防人工髋关节置换术后患者深静脉血栓的效果。方法将423例髋关节置换术患者按时间段分为对照组125例、实验组298例,对照组采用常规围手术期干预,实验组制定个案追踪图和护理质量管理追踪事项与评分标准进行追踪干预和效果评价。结果实验组护理质量总分97.76±3.25,得分率为97.76%;实验组深静脉血栓发生率显著低于对照组(P0.05)。结论追踪方法学用于预防人工髋关节置换术患者深静脉血栓效果显著。     

新型口服抗凝药物在预防全髋全膝关节置换术后血栓形成中的进展

目前全世界每年接受髋、膝关节置换手术的患者已超过了100万,而且人数不断增长。根据假体使用情况估计,我国每年接受关节置换患者数量已有20万[1]。全膝/髋关节置换术(total knee or hip replacement,TKR/THR)后患者面临静脉血栓栓塞(venous thromboembolism,VTE)发生的高风险。VTE包括深静脉血栓形成(deep venous thrombosis,DVT)和     

低分子肝素对食管癌术后深静脉血栓形成的预防作用

目的 探讨低分子肝素对食管癌术后深静脉血栓形成(DVT)的预防作用.方法 收集2016年1月至2021年1月于航天中心医院接受手术治疗的60例食管癌患者临床资料.根据术后用药方案不同分为观察组(n=26,术后应用低分子肝素)和常规组(n=34,术后未应用低分子肝素).比较两组患者治疗前(术后即刻)和治疗后(术后第11天...     

Apixaban versus enoxaparin for thromboprophylaxis after hip or knee replacement: pooled analysis of major venous thromboembolism and bleeding in 8464 patients from the ADVANCE-2 and ADVANCE-3 trials

In order to compare the effect of oral apixaban (a factor Xa inhibitor) with subcutaneous enoxaparin on major venous thromboembolism and major and non-major clinically relevant bleeding after total knee and hip replacement, we conducted a pooled analysis of two previously reported double-blind randomised studies involving 8464 patients. One group received apixaban 2.5?mg twice daily (plus placebo injection) starting 12 to 24 hours after operation, and the other received enoxaparin subcutaneously once daily (and placebo tablets) starting 12 hours (± 3) pre-operatively. Each regimen was continued for 12 days (± 2) after knee and 35 days (± 3) after hip arthroplasty. All outcomes were centrally adjudicated. Major venous thromboembolism occurred in 23 of 3394 (0.7%) evaluable apixaban patients and in 51 of 3394 (1.5%) evaluable enoxaparin patients (risk difference, apixaban minus enoxaparin, -0.8% (95% confidence interval (CI) -1.2 to -0.3); two-sided p = 0.001 for superiority). Major bleeding occurred in 31 of 4174 (0.7%) apixaban patients and 32 of 4167 (0.8%) enoxaparin patients (risk difference -0.02% (95% CI -0.4 to 0.4)). Combined major and clinically relevant non-major bleeding occurred in 182 (4.4%) apixaban patients and 206 (4.9%) enoxaparin patients (risk difference -0.6% (95% CI -1.5 to 0.3)). Apixaban 2.5 mg twice daily is more effective than enoxaparin 40 mg once daily without increased bleeding.     

Patient-reported outcomes after fixed- versus mobile-bearing total knee replacement: a multi-centre randomised controlled trial using the Kinemax total knee replacement

We compared patient-reported outcomes of the Kinemax fixed- and mobile-bearing total knee replacement in a multi-centre randomised controlled trial. Patients were randomised to the fixed- or the mobile-bearing prosthesis via a sealed envelope method after the bone cuts had been made in the operating theatre. Randomisation was stratified by centre and diagnosis. Patients were assessed pre-operatively and at eight to 12 weeks, one year and two years post-operatively. Validated questionnaires were used which included the Western Ontario MacMasters University, Short-Form 12, Mental Health Index-5, Knee Injury and Osteoarthritis Outcome Score for Knee-Related Quality of Life and Function in Sport and Recreation scales and a validated scale of satisfaction post-operatively. In total, 242 patients (250 knees) with a mean age of 68 years (40 to 80) were recruited from four NHS orthopaedic centres. Of these, 132 patients (54.5%) were women. No statistically significant differences could be identified in any of the patient-reported outcome scores between patients who received the fixed-bearing or the mobile-bearing knee up to two-years post-operatively.     

Patellar resurfacing in total knee replacement: a ten-year randomised prospective trial

A series of 100 consecutive osteoarthritic patients was randomised to undergo total knee replacement using a Miller-Galante II prosthesis, with or without a cemented polyethylene patellar component. Knee function was evaluated using the American Knee Society score, Western Ontario and McMaster University Osteoarthritis index, specific patellofemoral-related questions and radiographic evaluation until the fourth post-operative year, then via questionnaire until ten years post-operatively. A ten-point difference in the American Knee Society score between the two groups was considered a significant change in knee performance, with alpha and beta levels of 0.05. The mean age of the patients in the resurfaced group was 71 years (53 to 88) and in the non-resurfaced group was 73 years (54 to 86). After ten years 22 patients had died, seven were suffering from dementia, three declined further participation and ten were lost to follow-up. Two patients in the non-resurfaced group subsequently had their patellae resurfaced. In the resurfaced group one patient had an arthroscopic lateral release. There was no significant difference between the two treatment groups: both had a similar deterioration of scores with time, and no further patellofemoral complications were observed in either group. We are unable to recommend routine patellar resurfacing in osteoarthritic patients undergoing total knee replacement on the basis of our findings.     

Nadroparin or fondaparinux versus no thromboprophylaxis in patients immobilised in a below-knee plaster cast (PROTECT): A randomised controlled trial

BackgroundThe immobilisation of the lower leg is associated with deep vein thrombosis (DVT). However, thromboprophylaxis in patients with a below-knee plaster cast remains controversial. We examined the efficacy and safety of nadroparin and fondaparinux to ascertain the need for thromboprophylaxis in these patients.MethodsPROTECT was a randomised, controlled, single-blind, multicentre study that enrolled adults with an ankle or foot fracture who required immobilisation for a minimum of four weeks. The patients were randomly assigned (1:1:1) to a control group (no thromboprophylaxis) or to one of the intervention groups: daily subcutaneous self-injection of either nadroparin (2850 IE anti-Xa = 0.3 ml) or fondaparinux (2.5 mg = 0.5 ml). A venous duplex sonography was performed after the removal of the cast or earlier if thrombosis was suspected. The primary outcome was the relative risk of developing DVT in the control group compared with that in both intervention groups. This trial is registered at ClinicalTrials.gov, number NCT00881088.ResultsBetween April 2009 and December 2015, 467 patients were enrolled and assigned to either the nadroparin group (n = 154), the fondaparinux group (n = 157), or the control group (n = 156). A total of 273 patients (92, 92, and 94 patients, respectively) were analysed. The incidence of DVT in the nadroparin group was 2/92 (2.2%) compared with 11/94 (11.7%) in the control group, with a relative risk of 5.4 (95% CI 1.2–23.6; p = 0.011). The incidence of DVT in the fondaparinux group was 1/92 (1.1%), yielding a relative risk of 10.8 (95% CI 1.4–80.7; p = 0.003) compared with that in the control group. No major complications occurred in any group.ConclusionThromboprophylaxis with nadroparin or fondaparinux significantly reduces the risk of DVT in patients with an ankle or foot fracture who were treated in a below-knee cast without any major adverse events.     

Anteroposterior glide versus rotating platform low contact stress (LCS) knee arthroplasty: a randomised controlled trial

Background  

Fifty thousand knee replacements are performed annually in the UK at an estimated cost of ￡150 million. Post-operative improvement depends on a number of factors including implant design and patient associated factors. To our knowledge there are no published study's comparing the results of AP glide and rotating platform designs of LCS knee arthroplasty. Therefore we feel that a study is required to investigate and compare the effects of two types of LCS total knee arthroplasty on joint proprioception and range of motion.     

A randomised controlled trial of cemented versus cementless press-fit condylar total knee replacement: 15-year survival analysis

We report the long-term survival of a prospective randomised consecutive series of 501 primary knee replacements using the press-fit condylar posterior cruciate ligament-retaining prosthesis. Patients received either cemented (219 patients, 277 implants) or cementless (177 patients, 224 implants) fixation. Altogether, 44 of 501 knees (8.8%) underwent revision surgery (24 cemented vs 20 cementless). For cemented knees the 15-year survival rate was 80.7% (95% confidence interval (CI) 71.5 to 87.4) and for cementless knees it was 75.3% (95% CI 63.5 to 84.3). There was no significant difference between the two groups (cemented vs cementless; hazard ratio (HR) 0.83, 95% CI 0.45 to 1.52, p = 0.55). When comparing the covariates there was no significant difference in the rates of survival between the side of operation (HR 0.58, p = 0.07), age (HR 0.97, p = 0.10) and diagnosis (HR 1.25 p = 0.72). However, there was a significant gender difference, with males having a higher failure rate with cemented fixation (HR 2.48, p = 0.004). Females had a similar failure rate in both groups. This single-surgeon series, with no loss to follow-up, provides reliable data of the revision rates of one of the most commonly-used total knee replacements. The survival of the press-fit condylar total knee replacement remained good at 15 years, irrespective of the method of fixation.     

Subcutaneous versus intraarticular closed suction indwelling drainage after total knee arthroplasty: A randomised control trial

Background:

Total knee arthroplasty (TKA) is widely accepted treatment for moderate or severe osteoarthritis and rheumatoid arthritis. Significant blood loss can be seen during the early postoperative period where a blood transfusion may be necessary. Closed suction drainage is known to prevent the formation of hematomas in the operative field, decrease tension on incisions, diminish delayed wound healing and reduce the risk of infection. Subcutaneous indwelling closed suction drainage method has been known to be beneficial and an alternative to the intraarticular indwelling method. This prospective randomized study was to compare the visible, hidden, total blood loss and postoperative hemodynamic change of subcutaneous and intraarticular indwelling closed suction drainage method after TKA.

Materials and Methods:

One hundred and sixty patients with primary osteoarthritis who underwent unilateral TKA were enrolled; group A with subcutaneous (n = 78) and group B with intraarticular (n = 79) indwelling closed suction drainage method. Total blood loss, visible blood loss, internal blood loss, postoperative day 1, 5^th, 10^th day hemoglobin, hematocrit levels were compared. Allogeneic blood transfusion rate and complications related to soft tissue hematoma formation were additionally compared.

Results:

Allogenic transfusion requirements between subcutaneous drainage group and intraarticular drainage groups (6.4% vs. 24.1%) were significantly different (P = 0.002). Although the minor complications such as the incidence of bullae formation and the ecchymosis were higher in the subcutaneous indwelling group, the functional outcome at postoperative 2 year did not demonstrate the difference from intraarticular drainage group.

Conclusion:

Subcutaneous indwelling closed suction drainage method is a reasonable option after TKA for reduction of postoperative bleeding and transfusion rate.