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Effects of thromboembolism prophylaxis with dabigatran on perioperative blood loss and wound secretion in primary hip arthroplasty

Philipp Mommsen, Matthias Doering, Ehrenfried R O Hrs, Claus Christoph Egidy, Thorsten Gehrke, Christian Krettek & Daniel Kendoff

abstract

BACKGROUND
Low-molecular-weight heparins (LMWH), e.g. enoxaparin, represent the standard thromboprophylactic agents in Europe after total hip replacement. The oral direct thrombin inhibitor dabigatran etexilate provides comparable effectiveness and safety. The present study aimed to evaluate the influence of dabigatran etexilate on perioperative blood loss and wound secretion in total hip arthroplasty compared to enoxaparin.

METHODS
Patients receiving primary total hip replacement between January and June 2009 were included. The association between thromboembolism prophylaxis with dabigatran etexilate or enoxaparin and the perioperative blood loss was investigated. The effective blood loss (EBL) was calculated taking blood transfusions and the difference between preoperative haemoglobin and haemoglobin on the day of discharge into account. Additional comparison of wound secretion depending on thromboprophylactic agents was performed in a separate, prospectively collected patients' population. Statistical analysis was performed with χ<formula> ^{2}</formula>-Test, Student's t-test or Mann-Whitney U-test. Statistical significance was considered at p < 0.05.

RESULTS
198 patients (111 women, 87 men) with primary total hip arthroplasty were enrolled. Patients' mean age was 63.0 ± 11.9 years. Thromboembolism prophylaxis was performed in 111 patients (56.1%) with dabigatran etexilate, 87 patients (43.9%) received enoxaparin. No significant differences concerning EBL and wound secretion were found between both study groups. In the dabigatran etexilate group the EBL was 1.66 ± 0.56 l compared to 1.77 ± 0.65 l in patients with enoxaparin.

CONCLUSIONS
Dabigatran etexilate can safely be used for thromboembolism prophylaxis after primary total hip replacement without an increased risk for perioperative blood loss and prolonged wound secretion.
   
citation Mommsen P, Doering M, R O Hrs E, Egidy C C, Gehrke T, Krettek C, Kendoff D. Effects of thromboembolism prophylaxis with dabigatran on perioperative blood loss and wound secretion in primary hip arthroplasty. Technol Health Care 2014; 22:901-8.
   
type journal paper/review (English)
date of publishing 2014
journal title Technol Health Care (22/6)
ISSN electronic 1878-7401
pages 901-8
PubMed 25318954
DOI 10.3233/THC-140859