Key result
Fondaparinux (OR 0.58; p=0.025) or enoxaparin (OR 0.59; p=0.046) with mechanical prophylaxis significantly reduced pulmonary embolism compared to mechanical prophylaxis alone after THA or TKA.
Why the study?
Does fondaparinux or enoxaparin combined with mechanical prophylaxis reduce the occurrence of pulmonary embolism in patients undergoing total hip or knee arthroplasty?
Observational (n=49,678)
Yes
Does fondaparinux or enoxaparin combined with mechanical prophylaxis reduce the occurrence of pulmonary embolism in patients undergoing total hip or knee arthroplasty?
Fondaparinux or enoxaparin combined with mechanical prophylaxis significantly reduces the risk of pulmonary embolism after total hip or knee arthroplasty compared to mechanical prophylaxis alone.
May support combined prophylaxis to lower PE after THA/TKA; hypothesis-generating from observational data and needs RCT confirmation.
OBJECTIVES: The aim of this study was to estimate the effect of fondaparinux and enoxaparin combined with mechanical prophylaxis (MP) after total hip arthroplasty (THA) and total knee arthroplasty (TKA). We also investigated the occurrence of pulmonary embolism (PE) and its associated risk factors. METHODS: Data were retrospectively collected on patients who underwent THA or TKA between 2008 and 2010 from the Japanese Diagnosis Procedure Combination database (n = 49,678). We extracted information on sex, age, main diagnosis, types of anesthesia, duration of anesthesia, comorbidities, hospital volume, the use of MP, and the use of anticoagulant drugs. RESULTS: The overall occurrence of PE was 0.41%. Multivariate logistic regression analysis showed that the occurrence of PE was significantly higher in females (odds ratio, 2.17; p < 0.001, compared with males), TKA (1.47; p = 0.039, compared with THA), and longer-duration anesthesia (2.63; p = 0.008 in the ≥ 240-min. group compared with the ≤ 119-min. group). Compared with the MP-alone group, the occurrence of PE was significantly reduced in the fondaparinux group (0.58; p = 0.025) and the enoxaparin group (0.59; p = 0.046). CONCLUSIONS: Fondaparinux or enoxaparin combined with MP decreased the occurrence of PE. The risk factors for PE were female patients, TKA, and longer-duration anesthesia (≥ 240 min.).
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Shoda et al. (2014) conducted an observational in Total hip or knee arthroplasty (n=49,678). Fondaparinux or enoxaparin combined with mechanical prophylaxis vs. Mechanical prophylaxis alone was evaluated on Occurrence of pulmonary embolism (OR 0.58 (fondaparinux) and OR 0.59 (enoxaparin), p=0.025 (fondaparinux), 0.046 (enoxaparin)). Fondaparinux (OR 0.58; p=0.025) or enoxaparin (OR 0.59; p=0.046) with mechanical prophylaxis significantly reduced pulmonary embolism compared to mechanical prophylaxis alone after THA or TKA.
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