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Published on: February 28, 2012

Novel oral anticoagulants for thromboprophylaxis after orthopaedic surgery

Daniel J Quinlan1, Bengt I Eriksson

  • 1Department of Radiology, Kings College Hospital, London, United Kingdom.

Best Practice & Research. Clinical Haematology
|August 20, 2013
PubMed

Insights

New oral anticoagulants like dabigatran, rivaroxaban, and apixaban offer convenient prevention of venous thromboembolism after hip or knee surgery. They provide predictable effects without routine monitoring, improving patient care.

Area of Science:

  • Pharmacology and Clinical Medicine

Background:

  • New oral anticoagulants (NOACs) include direct thrombin inhibitors (dabigatran) and selective factor Xa inhibitors (rivaroxaban, apixaban).
  • These agents are approved for preventing venous thromboembolism (VTE) post-elective hip or knee arthroplasty.

Purpose of the Study:

  • To review the pharmacology, clinical trial outcomes, bleeding risks, and practical application of NOACs in orthopaedic practice.
  • To compare NOACs with conventional anticoagulant therapies.

Main Methods:

  • Literature review of pharmacology and clinical trial data for dabigatran, rivaroxaban, and apixaban.
  • Analysis of bleeding risk and drug interaction profiles.

Main Results:

  • NOACs demonstrate rapid onset, predictable effects, and minimal food/drug interactions, eliminating the need for routine coagulation monitoring.
  • They present a convenient alternative to parenteral low-molecular-weight heparins, fondaparinux, and vitamin K antagonists for VTE prophylaxis.

Conclusions:

  • NOACs are effective and convenient options for VTE prevention in major orthopaedic surgery.
  • Considerations for use include renal impairment, drug interactions, neuraxial anesthesia, and bleeding management.
Keywords:
anticoagulantapixabandabigatrandeep vein thrombosispulmonary embolismrivaroxabanthromboprophylaxistotal hip arthroplastytotal knee arthroplasty

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