Optimization of Approaches to the Prevention of Thromboembolic Complications after Total Hip Arthroplasty

Abstract

To choose the optimum scheme of anticoagulant therapy for the prevention of thromboembolic complications after total hip arthroplasty 86 patients were examined. The patients were randomly divided into 3 groups. In group 1 (n=29) prevention of thromboembolic complications was performed by subcutaneous injection of enoxaparin (40 mg) started 12 hours before the surgery. In group 2 (n=28) enoxaparin (40 mg) was started 12 hours after surgical intervention. In those groups thromboprophylaxis with enoxaparin was continued during hospitalization period and at discharge the patients were given recommendations to take dabigatran etexilate up to 35 days. In group 3 (n=29) patients received oral dabigatran etexilate, 110 mg 1 - 4 hours after surgery, followed by 220 mg once-daily both at hospital and out-patient stage of treatment. The average duration of hospitalization made up 8.9±1.2 days. Minimum fibrinogen and D-dimer levels as well as maximum APTT values were observed in patients from group 3 on the 5th postoperative day. Thromboelastogram showed that on day 5 both plasma and platelet hypocoagulation were most expressed in 3rd group. Preoperative thrombodynamics showed high rate of clot growth and high percentage of spontaneous clots formation in all three groups that assumed initial hypercoagulation with maximum decrease of the frequency of spontaneous clots formation against the background of dabigatran prophylaxis. The lowest number (3,4%) of thromboembolic complications, i.e. distal thromboses, were observed in patients from dabigatran etexilate group. Assessment of anticoagulant prophylaxis costs showed a clear advantage of the 3rd group.