Diz ve kalça artroplastisi sonrası ardışık terapi modalitelerinin (enoksaparin sonrası rivaroksaban veya dabigatran) tek başına enoksaparinkullanımı ile karşılaştırılması

Öz

Amaç: Majör ortopedik cerrahiler sonrası venöz tromboembolizm ve pulmoner embolinin önlenmesi hayati önem taşır ve bu konuda yeni tedavi modaliteleri geliştirilmektedir. Bu çalışmada diz ve kalça artroplastisi sonrası ardışık terapi modalitelerinin (enoksaparin sonrası rivaroksaban veya dabigatran) tek başına enoksaparin kullanımı ile karşılaştırılmasını amaçladık.

Çalışma planı: Bu prospektif, randomize, körlü olmayan çalışmada; total diz artroplastisi veya total kalça artroplastisi operasyonu yapılan 247 hastanın arasından uygun olan 180 hastaya operasyon sonrası derin ven trombozu profilaksisi amacıyla sadece enoksaparin (enoksaparin grubu) veya ardışık terapi modaliteleri (hastanede yatış süresince enoksaparin ve taburculuk sonrası rivaroksaban veya dabigatran [rivaroksaban grubu], [dabigatran grubu]) uygulandı. Tedavi modalitelerinin etkinlikleri semptomatik veya Doppler USG ile tanısı koyulmuş derin ven trombozunu önlemeleri iken güvenlikleri profilaksi periodu sırasında görülen kanama sıklığı olarak belirlendi.

Bulgular: Altıncı haftada yapılan Doppler USG ile hiçbir hastada derin ven trombozuna rastlanmadı. Hastanede yatış süresince sadece iki majör kanamaya rastlandı (enoksaparin grubunda bir [%1.6), dabigatran grubunda bir [%1.6]). Taburculuk sonrası hiçbir hastada majör kanamaya rastlanmadı. Üç grup arasında kanama açısından istatistiksel anlamlı fark bulunamadı (p>0.05).

Çıkarımlar: Ardışık tedavi modaliteleri, hastanede yatış süresince enoksaparin uygulamasının güvenilirliğinden ve taburculuk sonrası yeni oral antikoagülanların kullanım kolaylığından faydalanılabilinir.

Anahtar Kelimeler

• Derin ven tromboembolizm; yeni oral antikoagülan ilaçlar; ardışık terapi.

Comparison of switch-therapy modalities (enoxaparin to rivaroxaban/dabigatran) and enoxaparin monotherapy after hip and knee replacement

Öz

Objective: Prevention of deep venous thrombosis (DVT) and associated pulmonary embolism following major orthopedic surgeries is challenging, and there is an increased interest in developing new treatment strategies. We compared 2 switch-therapy modalities—enoxaparin to rivaroxaban and enoxaparin to dabigatran—and enoxaparin monotherapy for preventing DVT after total knee arthroplasty (TKA) and total hip arthroplasty (THA).
Methods: This was a prospective, non-blinded, randomized controlled study. We selected 180 eligible patients out of 247 patients undergoing TKA or THA. During the preoperative checkup, patients were randomized to receive either enoxaparin (enoxaparin group) or switch-therapy regimens, comprising enoxaparin during hospitalization and rivaroxaban (rivaroxaban group) or dabigatran (dabigatran group) during the outpatient period. All patients were evaluated for DVT using Doppler ultrasonography (USG) 6 weeks postoperatively. The primary efficacy outcome was the prevention of symptomatic or Doppler ultrasonography (USG)-proven DVT, whereas the primary safety outcome was the incidence of bleeding during the DVT-prophylaxis period.
Results: Doppler USG at 6 weeks after surgery revealed no signs of DVT in any patient. During the hospitalization period, only 2 major bleeding events were reported (1 [1.6%] in the enoxaparin group and 1 [1.6%] in the dabigatran group). No major bleeding events were reported during the outpatient follow-up period in any group. Differences among the 3 groups regarding bleeding events were not statistically significant (p>0.05).
Conclusion: When using switch-therapy modalities, clinicians can take advantage of the safety of enoxaparin during the hospitalization period and ease of use of new oral anticoagulant drugs during the outpatient period.

Anahtar Kelimeler

• Deep venous thromboembolism
• new oral anticoagulant drugs
• switch therapy

Kaynakça

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