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international normalized ratio AND arthroplasty

Yasuhisa Izushi, Naofumi Shiota, Tomonori Tetsunaga, Kenichi Shimada, Takashi Egawa, Tsukasa Kiuchi, Toru Sato, Ritsugi Takuma, Yoichiro Takami
BACKGROUND: Postoperative anemia is a common complication after total hip arthroplasty (THA). However, the effect of edoxaban on postoperative anemia after THA remains unclear. Here, we retrospectively evaluated the clinical assessment of postoperative anemia and the associated changes of coagulation parameters in patients undergoing thromboprophylaxis with edoxaban compared with fondaparinux as a conventional anticoagulant thromboprophylactic agent after THA. METHODS: One hundred and forty-nine patients who underwent THA from July 2010 to June 2012 were divided into two groups, according to whether they were operated on before or after the approval of edoxaban: the fondaparinux group (Group F: 86 patients) and the edoxaban group (Group E: 63 patients)...
May 5, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Adam I Edelstein, Clara Terzaghi, Brandon Nudelman, Charles Qin, Mary Kwasny, David W Manning
BACKGROUND: Venous thromboembolism chemoprophylaxis with warfarin is common after total joint arthroplasty. Early response to warfarin initiation has been theorized to engender a transient increase in the risk of venous thromboembolism. We hypothesized that a rapid rise in the international normalized ratio is a risk factor for venous thromboembolism after total joint arthroplasty. METHODS: This study was a retrospective analysis of Medicare patients undergoing elective total joint arthroplasty who were given nomogram-dosed warfarin for venous thromboembolism prophylaxis...
February 15, 2018: Journal of the American Academy of Orthopaedic Surgeons
Matthew A Harb, Max Solow, Jared M Newman, Nipun Sodhi, Robert Pivec, Jaiben George, Assem A Sultan, Anton Khlopas, Neil V Shah, Martin W Roche, Michael A Mont
As the use of disease modifying antirheumatic drugs have increased, it remains unclear whether or not this has affected the rates of total knee arthroplasty (TKA) in rheumatoid arthritis (RA) patients. Therefore, the purpose of this study was to evaluate the annual trends of RA patients who underwent TKA. Specifically, we evaluated: (1) the annual trends of TKAs due to RA in the United States population; and (2) the annual trends in the proportion of TKAs due to RA in the United States. The Nationwide Inpatient Sample was used to identify all patients who underwent TKA between 2002 and 2013 ( n  = 6,492,873)...
January 3, 2018: Journal of Knee Surgery
Brian F Gage, Anne R Bass, Hannah Lin, Scott C Woller, Scott M Stevens, Noor Al-Hammadi, Juan Li, Tomás Rodríguez, J Philip Miller, Gwendolyn A McMillin, Robert C Pendleton, Amir K Jaffer, Cristi R King, Brandi DeVore Whipple, Rhonda Porche-Sorbet, Lynnae Napoli, Kerri Merritt, Anna M Thompson, Gina Hyun, Jeffrey L Anderson, Wesley Hollomon, Robert L Barrack, Ryan M Nunley, Gerard Moskowitz, Victor Dávila-Román, Charles S Eby
Importance: Warfarin use accounts for more medication-related emergency department visits among older patients than any other drug. Whether genotype-guided warfarin dosing can prevent these adverse events is unknown. Objective: To determine whether genotype-guided dosing improves the safety of warfarin initiation. Design, Setting, and Patients: The randomized clinical Genetic Informatics Trial (GIFT) of Warfarin to Prevent Deep Vein Thrombosis included patients aged 65 years or older initiating warfarin for elective hip or knee arthroplasty and was conducted at 6 US medical centers...
September 26, 2017: JAMA: the Journal of the American Medical Association
Kazuki Kodato, Kazunari Ishida, Nao Shibanuma, Akihiko Toda, Koji Takayama, Shinya Oka, Shinya Hayashi, Shingo Hashimoto, Masahiro Kurosaka, Ryosuke Kuroda, Tomoyuki Matsumoto
BACKGROUND: Deep vein thrombosis (DVT) is one of the main complications following total knee arthroplasty (TKA). In this study, oral administration of 15 mg edoxaban (a factor Xa inhibitor) once daily for 14 days efficiently prevented the incidence of DVT. Our hypothesis was that prothrombin time-international normalized ratio (PT-INR) on the third postoperative day could predict the incidence of DVT following TKA. METHODS: In this study, 286 subjects were enrolled and divided into two groups according to the presence or absence of DVT...
January 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Jeffrey B Walker, Patrick L Nguyen, Ulrich H Schmidt, Rodney A Gabriel
BACKGROUND: There is sparse evidence on the benefit of neuraxial (NA) vs general anesthesia (GA) as the primary anesthetic in postoperative outcomes following bilateral total knee arthroplasty. We sought to elucidate differences in outcomes in this surgical population using a national database. METHODS: We used data from the National Surgical Quality Improvement Program from 2007 to 2013 and compared rates of various postoperative outcomes in propensity-matched cohorts (NA vs GA)...
June 23, 2017: Journal of Arthroplasty
Robert Kolundžić, Marijana Šimić Jovičić, Maja Ðinkić, Tadija Petrović, Tomislav Crnković, Vladimir Trkulja
Aim To identify modes of venous thromboembolism (VTE) prophylaxis in patients undergoing elective major orthopaedic surgery (total hip or knee arthroplasty, THA/TKA) at a single university-associated hospital in Croatia. Methods A retrospective analysis of consecutive patients subjected to THA or TKA over a two-year period (2014-2015) with a focus on anticoagulation during the first 15 post-surgical days (period of highest VTE risk). Results Of 603 identified patients three (0.5%) were not anticoagulated (haemophilia) and others received perioperative doses of low molecular weight heparins (LMWH)...
August 1, 2017: Medicinski Glasnik
Li-Hong Wang, Dong-Juan Xu, Xian-Jiao Wei, Hao-Teng Chang, Guo-Hong Xu
BACKGROUND: At present, the exact mechanism of postoperative delirium has not been elucidated. The purpose of this study was to analyze the incidence of delirium in patients undergoing orthopedic surgeries and to explore possible related factors. METHODS: This is a retrospective study. We used 582 patients who had undergone orthopedic surgery between January 2011 and December 2014. The surgeries consisted of 155 cases of internal fixation for intertrochanteric fracture (IFIF), 128 cases of femoral head replacement (FHR), 169 cases of total hip arthroplasty (THA) and 130 cases of total knee arthroplasty (TKA)...
November 23, 2016: BMC Psychiatry
Naum Shaparin, James Widyn, Singh Nair, Irene Kho, David Geller, Ellise Delphin
BACKGROUND: There is evidence that very obese patients (body mass index [BMI] >40 kg/m(2)) undergoing hip replacement have longer average hospital stays, as well as higher rates of complications and readmission compared with patients with normal BMI. However, there are sparse data describing how overweight and obese patients fare in the period immediately after hip replacement surgery compared with patients with low or normal BMI. In this study, we sought to explore the association of BMI with the rate of early postoperative complications in patients undergoing total hip arthroplasty...
August 2016: Journal of Clinical Anesthesia
Menachem M Meller, Nader Toossi, Norman A Johanson, Mark H Gonzalez, Min-Sun Son, Edmund C Lau
BACKGROUND: This study investigated the risk and cost of postoperative complications associated with morbid and super obesity after total knee arthroplasty (TKA). METHODS: A retrospective cohort study was conducted of patients who underwent TKA using Medicare hospital claims data. The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code V85.4x was used to identify morbidly obese patients (body mass index [BMI] ≥40 kg/m(2)) and superobese patients (BMI ≥50 kg/m(2)) in 2011-2013...
October 2016: Journal of Arthroplasty
Eric S Wise, Stephen P Gadomski, William G McMaster, Robert J Wilson, Justin K Nelms, Kyle M Hocking, Colleen M Brophy
AIMS: This study characterizes the influence of genotype at two loci on warfarin response after arthroplasty. METHODS: 121 postarthroplasty patients given warfarin thromboprophylaxis were reviewed for international normalized ratio (INR) values on the first three days postoperatively. Significant differences among genotypes in INR values on each of the first three postoperative days were assessed. RESULTS: Wild-type patients at both loci (∼23% of patients) had yet to reach therapeutic INR (1...
December 2015: Journal of Orthopaedics
Yasuhisa Izushi, Yoichiro Takami, Naofumi Shiota, Tomonori Tetsunaga, Yusuke Ookura, Kenichi Shimada, Takashi Egawa, Tsukasa Kiuchi, Toru Sato, Ritsugi Takuma
Edoxaban, an oral direct factor Xa inhibitor, was developed and approved for anticoagulant thromboprophylaxis after total knee arthroplasty (TKA). We retrospectively investigated the postoperative anemia by oral administration of edoxaban 30 mg compared with fondaparinux 2.5 mg in TKA patients. Two hundred twenty nine patients who underwent TKA in National Hospital Organization Okayama Medical Center from July 2010 to June 2012 were divided into two groups; pre and post approval of edoxaban: fondaparinux-group (F-group) and edoxaban-group (E-group)...
2016: Biological & Pharmaceutical Bulletin
Jia Li, Jinzhu Zhao, Chongru He, Wenwen Tong, Yuming Zou, Weidong Xu
BACKGROUND: This study was conducted to compare the blood loss during primary total hip arthroplasty (THA) between ankylosing spondylitis (AS) and hip osteoarthritis (OA). METHODS: We reviewed 120 THAs in 68 patients comprising 3 groups: AS with total bony ankylosis of the hips (ASB), AS with stiff hips (ASS), and OA. Demographics, perioperative laboratory values, intraoperative data, blood loss, transfusion rate, transfusion reactions, surgical complications, hospitalization cost, and length of stay (LOS) were collected and analyzed among ASB, ASS, and OA groups...
July 2016: Journal of Arthroplasty
Hyun-Jung Shin, Hyo-Seok Na, Young-Tae Jeon, Gwan Woo Lee, Sang-Hwan Do
BACKGROUND: Hydroxyethyl starch (HES) solutions are used as plasma expanders for correcting hypovolemia, but can lead to impaired coagulation. We evaluated the changes in hematological and hemostatic profiles with three types of HES. METHODS: Patients were randomized to receive volume replacement with 10% pentastarch 260/0.45 in 0.9% saline (Group-PEN, n = 25), 6% tetrastarch 130/0.4 in 0.9% saline (Group-TETS, n = 25), or 6% tetrastarch 130/0.4 in a balanced electrolyte solution (Group-TETB, n = 25)...
August 2015: Korean Journal of Anesthesiology
Stephanie E Cho, Thomas Delate, Daniel M Witt, Nathan P Clark
INTRODUCTION: The purpose of this study was to describe the incidence of symptomatic venous thromboembolism (VTE), clinically-relevant bleeding, and death among a real-world population receiving warfarin prophylaxis targeting an international normalized ratio (INR) of 1.5 to 2.5 for four weeks following total knee arthroplasty (TKA). MATERIALS AND METHODS: This retrospective, observational study included patients receiving warfarin following a TKA between August 1, 2005 and July 31, 2009 identified in the Kaiser Permanente Total Joint Replacement Registry...
February 2015: Thrombosis Research
H J Shin, H S Na, S H Do
Total hip arthroplasty results in substantial blood loss in the peri-operative period. We evaluated the effects of acute normovolaemic haemodilution on blood coagulation and platelet function in 11 patients undergoing total hip arthroplasty. We performed acute normovolaemic haemodilution and haematological tests, rotational thromboelastometry (ROTEM(®) ) and whole-blood impedance aggregometry. Blood samples were obtained at three time points: (i) before the initiation of acute normovolaemic haemodilution; (ii) 20 min after completion of acute normovolaemic haemodilution; and (iii) 20 min after retransfusion...
March 2015: Anaesthesia
T Fuji, C-J Wang, S Fujita, Y Kawai, T Kimura, S Tachibana
Edoxaban, an oral direct factor Xa inhibitor, has proven antithrombotic efficacy. In a multicenter, phase II study, 264 total hip arthroplasty (THA) patients randomly received edoxaban 15 or 30 mg once daily or enoxaparin 2000IU (20-mg) twice daily for 11-14 days. Thromboembolic event incidences were 3.8% (3/78), 2.8% (2/72), and 4.1% (3/74) for edoxaban 15-mg, 30-mg, and enoxaparin, respectively (P=1.00). Edoxaban-induced prolongation of prothrombin time, international normalized ratio, and activated partial thromboplastin time were proportional to plasma edoxaban concentration...
December 2014: Journal of Arthroplasty
Mahmut Argun, Mithat Oner, Mehmet Saglamoglu, Ibrahim Karaman, Ahmet Guney, Mehmet Halici, Ibrahim Halil Kafadar
OBJECTIVE: To evaluate the efficacy and safety of fondaparinux compared with nadroparin for prevention of venous thromboembolism after arthroplasty. PATIENTS AND METHODS: One hundred fifteen patients were randomized into 2 treatment groups. Patients were given fondaparinux in Group I and nadroparin in Group II. Measurements were performed on Days 1, 5, and 21. The wound area was assessed with a subjective visual analog scale. RESULTS: The blood counts, clinical biochemical tests, and coagulation tests (ie, thrombin time, partial thromboplastin time, activated partial thromboplastin time, fibrinogen, prothrombin time-International Normalized Ratio, and antithrombin III activity) did not show statistically significant differences between Group I and Group II...
June 2013: Current Therapeutic Research, Clinical and Experimental
Javad Parvizi, Ronald Huang, Ibrahim J Raphael, William V Arnold, Richard H Rothman
BACKGROUND: Prophylaxis for pulmonary embolism (PE) after total joint arthroplasty (TJA) presents the clinical dilemma of balancing the risk of postoperative thrombotic risk and anticoagulation-related complications such as bleeding, hematoma formation, and infection. Risk stratification of patients undergoing TJA is needed to tailor prophylaxis based on thrombotic and bleeding risk. QUESTIONS/PURPOSES: The purpose of this study was to identify the preoperative comorbidities that were associated with an increased risk of symptomatic PE after joint arthroplasty in a large group of patients who had TJAs and who were treated with either aspirin or warfarin...
March 2014: Clinical Orthopaedics and related Research
Erik Hansen, Joel B Durinka, James A Costanzo, Matthew S Austin, Gregory K Deirmengian
BACKGROUND: Persistent wound drainage after hip arthroplasty is a risk factor for periprosthetic infection. Negative pressure wound therapy (NPWT) has been used in other fields for wound management although it is unclear whether the technique is appropriate for total hip arthroplasty. QUESTIONS/PURPOSES: We determined (1) the rate of wound complications related to use of NPWT for persistent incisional drainage after hip arthroplasty; (2) the rate of resolution of incisional drainage using this modality; and (3) risk factors for failure of NPWT for this indication...
October 2013: Clinical Orthopaedics and related Research
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