Comparative assessment of effectiveness of thromboprophylaxis by novel oral anticoagulants at total hip replacement: 616-005.7:615.273.53:616.728.2-089.28

Abstract

Introduction. Venous thromboses and pulmonary embolism are the most common, socially and economically signifi cant types of human pathology. At endoprosthesis replacement of large joints venous thromboembolic complications often develop.

Aim. A comparative study of thrombotic readiness manifestations under new oral anticoagulants (NOACs) administration.

Materials and methods. A comparative analysis of thrombotic readiness was performed in 195 patients after total hip replacement under NOACs administration — rivaroxaban (73 patients) or dabigatran etexilate (122 patients). For this purpose integral methods were used to study hemostatic system (thrombin generation test and thromboelastometry) as well as determination of intravascular coagulation markers — thrombin-antithrombin (TAT) complex and D-dimers.

Results. No differences were found between compared groups of patients either in number of episodes of venous thrombosis or in time of its onset and localization. Also there was no noticeable difference in hemostatic parameters during the period of NOACs administration. However in the long-term period (at 1 and 3 months after surgery) in cases of dabigatran etexilate usage «rebound effect» was fi xed that manifested by a relatively higher intensity of thrombin  generation in blood plasma, higher level of TAT complex and higher density of fi brin clot (according to MCF parameter in thromboelastometry).

Conclusion. We consider that the revealed regularity should be taken into account in choosing anticoagulant for thromboprophylaxis at orthopedic patients who have permanent or long-acting thrombogenic risk factors.

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