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November 13-14, 2019 | London, UK
ORTHOPEDICS, OSTEOPOROSIS & TRAUMA
12
th
International Conference on
Journal of Orthopaedics Trauma Surgery and
Related Research
Orthopedics 2019
November 13-14, 2019
J Orthop Trauma Surg Rel Res, Volume 14
Volume: 14 | ISSN: 1897-2276
Safety and efficacy of Apixaban and Enoxaparin in patients undergoing total hip
arthroplasty and total knee arthroplasty
Kishor Kunal
All India Institute of Medical Sciences, India
Statement of the Problem
: Venous thromboembolism is very common after a major orthopedic surgery like arthroplasty. Even
with thrombo-prophylaxis, subclinical DVT after THA is 15-20% and after TKA is 30-40%. According to ACCP, apixaban is
preferred if parenteral therapy is to be avoided, in CAD patients and in patients having dyspepsia or GI bleeding while enoxaparin
is to be preferred in liver diseases or those having pregnancy risk or pregnancy. NICE guidelines prefer enoxaparin, though it
recommends use of apixaban where enoxaparin/ rivaroxaban / aspirin cannot be used.
Methodology & Theoretical Orientation
: A prospective observational study was carried out with aim to observe the incidence
of symptomatic and asymptomatic DVT and PE and safety profiles in patients of THA/ TKA managed with two different
chemoprophylaxis regimes, apixaban and enoxaparin- for 2 weeks following TKA and 5 weeks following THA.
Findings
: In the undergoing study, 54 patients were analyzed from Oct 2018 to July 2019 with 26 under Apixaban and 28 under
Enoxaparin. Irrespective of the type of arthroplasty and duration of prophylaxis, none among them developed symptomatic or
asymptomatic DVT/ PE, however, 7.69% (2/26) on Enoxaparin had episodes of fall in saturation and chest discomfort with
CTPA showing normal reports. Also while Enoxaparin had a tendency for more local and systemic skin reactions (11.53%),
local subcutaneous swelling(3.84%), Apixaban had more tendency to create wound complications such as soakage of dressing
(12.5%), and increased drain collection leading to prolonged drain insertion periods which had a theoretical increased risk of
infection. Also, apixaban was not found to be safe in patients with cardiac condition and induced AF post-op in a relatively young
cardiac patient and was responsible for TIA (Transient Ischemic Attack) in one old patient.
Conclusion & Significance
: Though both Apixaban and Enoxaparin is equally effective in thromboprophylaxis, Enoxaparin
tend to have more skin and chest related complications and Apixaban tend to have more cardiac, nervous and wound related
complications. Recommendations are made for thromboprophylaxis with either of them in view of patient profile.
Biography
Kishor Kunal is working as a resident at AIIMS, Jodhpur. A writer, philanthropist and philosopher by passion, he endeavors not just
for being a care- giver but also in finding the best and latest technology to help the mankind. He has worked in several organizations
uplifting the current status of medical fraternity in India and continues to be a dynamic visionary in the field of medicine and social
sciences.
drkunal2408@gmail.com