The new oral anticoagulants, do they change the benefit vs. risk for
thromboprophylaxis in association to ambulatory surgery?
Author(s): Squizzato A, Romualdi E, Dentali F, Ageno W.
Affiliation(s): Research Center on Thromboembolic Disorders and on Antithrombotic Therapies,
Department of Clinical Medicine, University of Insubria, Varese, Italy.
alexsquizzo@libero.it
Publication date & source: 2010, Curr Opin Anaesthesiol. , 23(6):722-5
PURPOSE OF REVIEW: Several randomized controlled trials have shown that
pharmacological thromboprophylaxis with low-dose unfractionated heparin (UFH),
low molecular weight heparin (LMWH) or fondaparinux reduces venous
thromboembolism (VTE) after general surgery. No high-quality evidence supports
the use of pharmacological thromboprohylaxis with traditional antithrombotic
drugs in patients undergoing ambulatory surgery without additional VTE risk
factors, stratified at low risk of VTE by the American College of Chest
Physicians guidelines. Two new drug classes, the direct thrombin and factor Xa
(FXa) inhibitors, have been developed with a potentially better risk-benefit
profile.
RECENT FINDINGS: Oral administration, predictable anticoagulant responses, low
potential for drug-drug interactions render direct thrombin and factor Xa
inhibitors good candidates to replace UFH, LMWH and fondaparinux for VTE
prophylaxis. Most of all, the positive results of the first published clinical
trials in orthopedic thromboprophylaxis allowed dabigatran etexilate and
rivaroxaban to be licensed in Canada and in European Union for the prevention of
VTE in patients undergoing hip-replacement and knee-replacement surgery.
SUMMARY: No randomized trials with the new anticoagulants are ongoing in
ambulatory surgery. However, currently available drugs--that is UFH, LMWH or
fondaparinux--are administered subcutaneously and the new anticoagulants would
offer the clear advantage of an oral administration, without request for blood
testing to monitor potential adverse effects such as heparin-induced
thrombocytopenia, thus potentially simplifying the treatment out of the hospital.
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