Tromboseprofylakse ved hoftefrakturkirurgi og hofte- og knaeralloplastik. Er de nye antikoagulantia bedre end de hidtil anvendte?
Engelsk titel: Thromboprophylaxis in hip and knee arthroplasty. Are the new anticoagulants better than those previously used?
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Författare:
Dalsgaard Nielsen J
Email: joeda@gentoftehosp.kbhamt.dk
Språk: Dan
Antal referenser: 21
Dokumenttyp:
Översikt
UI-nummer: 05051819
Sammanfattning
Although thromboprophylaxis is now used routinely in many surgical patients, surgery is still responsible for approximately one third of all cases of venous thromboembolism (VTE). Therefore, there is still a need to develop more effective thromboprophylactic regimens, especially for hip and knee arthroplasty, where the risk of postoperative VTE is higher than in general surgery. Two new anticoagulant drugs, fondaparinux and melagatran/ximelagatran, have recently been evaluated in a number of phase III trials. Fondaparinux is a synthetic pentasaccharide. Like heparin, fondaparinux accelerates the effect of antithrombin; however, it has a much longer half-life (14 hours). Melagatran is a synthetic thrombin inhibitor. The prodrug ximelagatran can be given orally. Trials have demonstrated the importance of correct timing of thromboprophylaxis and suggest that it is possible to eliminate the problem of postoperative VTE almost completely.