nickji
member
- Joined
- Mar 8, 2009
- Messages
- 163
- Age
- 80
- Location
- Travelling for 39 years
- Gender
- Male
- Country
United Kingdom
Hi Everyone,
This subject has been discussed in a previous recent thread, but mixed up with questions about Ted's and alcohol. The literature is so enormous and so contradictory, and the subject so important, that I feel it deserves a new thread. If not, I'm sure the mods will move this post appropriately.
On the site: https://www.totaljoints.info/previous_news.htm
scrolling down to the section headed:POTENT DRUGS AGAINST DVT ASSOCIATED WITH HIGHER RISK OF DEATH AFTER TOTAL HIP REPLACEMENT
and dated 10/4/08, I went to a PubMed link in the citations and came across this study, which seems worth quoting:
Sharrock NE, Gonzalez Della Valle A, Go G, Lyman S, Salvati EA.
Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. [email protected]
Anticoagulation for thromboprophylaxis after THA and TKA has not been confirmed to diminish all-cause mortality. We determined whether the incidence of all-cause mortality and pulmonary embolism in patients undergoing total joint arthroplasty differs with currently used thromboprophylaxis protocols. We reviewed articles published from 1998 to 2007 that included 6-week or 3-month incidence of all-cause mortality and symptomatic, nonfatal pulmonary embolism. Twenty studies included reported 15,839 patients receiving low-molecular-weight heparin, ximelagatran, fondaparinux, or rivaroxaban (Group A); 7193 receiving regional anesthesia, pneumatic compression, and aspirin (Group B); and 5006 receiving warfarin (Group C). All-cause mortality was higher in Group A than in Group B (0.41% versus 0.19%) and the incidence of clinical nonfatal pulmonary embolus was higher in Group A than in Group B (0.60% versus 0.35%). The incidences of all-cause mortality and nonfatal pulmonary embolism in Group C were similar to those in Group A (0.4 and 0.52, respectively). Clinical pulmonary embolus occurs despite the use of anticoagulants. Group A anticoagulants were associated with the highest all-cause mortality of the three modalities studied.
The original site goes further and says that the quoted study also states:
“We believe that ACCP should reconsider their guidelines to reflect the fact that PE occurs despite the use of potent anticoagulants and may, in fact, expose patients to increased mortality after surgery." (ACCP = American College of Chest Physicians).
It would be very interesting to hear if you have come across other expert opinion, or know of actual cases, that either do or do not support this study and others cited in the original site I mentioned, all of which seem to be in favour of aspirin and against the modern high potency drugs.
I'm off to find a Willow tree....
All the best
Nick
This subject has been discussed in a previous recent thread, but mixed up with questions about Ted's and alcohol. The literature is so enormous and so contradictory, and the subject so important, that I feel it deserves a new thread. If not, I'm sure the mods will move this post appropriately.
On the site: https://www.totaljoints.info/previous_news.htm
scrolling down to the section headed:POTENT DRUGS AGAINST DVT ASSOCIATED WITH HIGHER RISK OF DEATH AFTER TOTAL HIP REPLACEMENT
and dated 10/4/08, I went to a PubMed link in the citations and came across this study, which seems worth quoting:
Sharrock NE, Gonzalez Della Valle A, Go G, Lyman S, Salvati EA.
Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. [email protected]
Anticoagulation for thromboprophylaxis after THA and TKA has not been confirmed to diminish all-cause mortality. We determined whether the incidence of all-cause mortality and pulmonary embolism in patients undergoing total joint arthroplasty differs with currently used thromboprophylaxis protocols. We reviewed articles published from 1998 to 2007 that included 6-week or 3-month incidence of all-cause mortality and symptomatic, nonfatal pulmonary embolism. Twenty studies included reported 15,839 patients receiving low-molecular-weight heparin, ximelagatran, fondaparinux, or rivaroxaban (Group A); 7193 receiving regional anesthesia, pneumatic compression, and aspirin (Group B); and 5006 receiving warfarin (Group C). All-cause mortality was higher in Group A than in Group B (0.41% versus 0.19%) and the incidence of clinical nonfatal pulmonary embolus was higher in Group A than in Group B (0.60% versus 0.35%). The incidences of all-cause mortality and nonfatal pulmonary embolism in Group C were similar to those in Group A (0.4 and 0.52, respectively). Clinical pulmonary embolus occurs despite the use of anticoagulants. Group A anticoagulants were associated with the highest all-cause mortality of the three modalities studied.
The original site goes further and says that the quoted study also states:
“We believe that ACCP should reconsider their guidelines to reflect the fact that PE occurs despite the use of potent anticoagulants and may, in fact, expose patients to increased mortality after surgery." (ACCP = American College of Chest Physicians).
It would be very interesting to hear if you have come across other expert opinion, or know of actual cases, that either do or do not support this study and others cited in the original site I mentioned, all of which seem to be in favour of aspirin and against the modern high potency drugs.
I'm off to find a Willow tree....
All the best
Nick
(got your back = I will protect you so nothing sneaks up behind you);)
