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international normalized ratio AND arthroplasty

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
Edith A Nutescu, Adriana Bautista, Weihua Gao, William L Galanter, Glen T Schumock, Samir H Mody, Brahim K Bookhart, Bruce L Lambert
PURPOSE: Clinical and resource-utilization outcomes associated with warfarin anticoagulation after major orthopedic surgery were evaluated. METHODS: Consecutive patients who received postsurgical prophylaxis with warfarin within 24 hours of total knee replacement (TKR) or total hip replacement (THR) surgery and who were referred to and had outpatient follow-up for anticoagulation management in a single-center, university-based antithrombosis clinic from January 1, 1998, to January 1, 2009, were included in the study...
March 1, 2013: American Journal of Health-system Pharmacy: AJHP
Blake P Gillette, Lori J DeSimone, Robert T Trousdale, Mark W Pagnano, Rafael J Sierra
BACKGROUND: The use of antifibrinolytic medications in hip and knee arthroplasty reduces intraoperative blood loss and decreases transfusion rates postoperatively. Tranexamic acid (TXA) specifically has not been associated with increased thromboembolic (TE) complications, but concerns remain about the risk of symptomatic TE events, particularly when less aggressive chemical prophylaxis methods such as aspirin alone are chosen. QUESTIONS/PURPOSES: We determined whether the rate of symptomatic TE events differed among patients given intraoperative TXA when three different postoperative prophylactic regimens were used after primary THA and TKA...
January 2013: Clinical Orthopaedics and related Research
Florian D Naal, Hermes H Miozzari, Michael Schär, Tobias Hesper, Hubert P Nötzli
BACKGROUND: Surgical treatment of femoroacetabular impingement (FAI) includes both open and arthroscopic procedures. Encouraging results have been reported for the majority of patients after surgical hip dislocation; however, most of these reports were short term and included only small cohorts. PURPOSE: To determine the results of surgical hip dislocation in a large cohort of FAI patients at a midterm follow-up. STUDY DESIGN: Case series; Level of evidence, 4...
July 2012: American Journal of Sports Medicine
Yong-jiang Li, Chun-yuan Cai, Li-cheng Zhang, Guo-jing Yang, De-biao Zhou, Mao-xiu Peng, Wen-liang Chen, Liang-wei Zhao
OBJECTIVE: To investigate safe range of acetabular prosthesis angle and the optimum combination of cup and neck in the range of activities of daily living (ADL). METHODS: A three-dimensional generic parametric and kinematic simulation module of THA was developed. Range of motion (ROM) of flexion > or = 110 degrees, internal-rotation > or = 30 degrees at 90 degrees flexion, extension > or = 30 degrees and external rotation > or = 40 degrees were defined as the normal criteria for desired ROM for activities of daily living (ADL), and ROM of flexion > or = 120 degrees, internal-rotation > or = 45 degrees at 90 degrees flexion, extension > or = 30 degrees and external rotation > or = 40 degrees as the severe criteria...
November 2011: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
William E Dager
BACKGROUND: Guidelines for the prevention of venous thromboembolism (VTE) after elective total hip or knee arthroplasty (THA/TKA) have been developed separately by the American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP). Differences exist in approaches to preventing postoperative VTE through prophylaxis. OBJECTIVE: To compare trials using vitamin K antagonists (VKAs) and differences in guidelines to determine the benefits and drawbacks of warfarin for VTE prophylaxis following THA/TKA...
January 2012: Annals of Pharmacotherapy
R Chana, L Salmon, A Waller, L Pinczewski
We evaluated the safety and efficacy of total knee replacement in patients receiving continuous warfarin therapy. We identified 24 consecutive patients receiving long-term warfarin therapy who underwent total knee replacement between 2006 and 2008 and compared them with a group of age- and gender-matched patients not on long-term anticoagulation. Primary observations were changes in haemoglobin, transfusion rates and complications. Secondary observations were fluctuations in the international normalised ratio (INR) and post-operative range of movement...
November 2011: Journal of Bone and Joint Surgery. British Volume
Beth L Nordstrom, Sumesh Kachroo, Kathy H Fraeman, Edith A Nutescu, Jeff R Schein, Alan Fisher, Brahim K Bookhart
OBJECTIVE: Warfarin is frequently used for the prevention of venous thromboembolism (VTE) after total hip or knee arthroplasty (THA/TKA). The current study was conducted to determine the association between international normalized ratio (INR) levels and VTE outcomes. METHODS: Patients who received warfarin following THA/TKA were followed for up to 90 days using an electronic health record database. INR measurements were categorized based on American College of Chest Physicians (ACCP) guidelines...
October 2011: Current Medical Research and Opinion
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