Abstract
Patients undergoing major orthopedic surgery face an increased risk of venous thromboembolism (VTE) in the days and weeks after surgery. In recent years, the routine use of anticoagulants has played a significant role in reducing the morbidity and mortality associated with VTE after major orthopedic surgery. Currently recommended prophylactic strategies include low-molecular-weight heparins at usual high-risk doses, fondaparinux, and adjusted-dose vitamin K antagonists such as warfarin. New oral anticoagulants have been developed and are now approved for the prevention of VTE in patients undergoing elective hip or knee replacement surgery. Few studies have evaluated the efficacy and safety of thromboprophylaxis in patients undergoing minimally invasive surgical procedures, such as knee arthroscopy, or in patients with fractures of the lower extremities or soft-tissue injuries. In general, these conditions, which may occur as a consequence of sports injuries, are defined as of low to moderate risk for VTE and routine use of thromboprophylaxis is not warranted. However, it becomes crucial to carefully assess VTE risk factors in each patient in order to identify higher-risk situations and to prescribe adequate prophylactic strategies.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Cohen AT, Agnelli G, Anderson FA et al (2007) Venous thromboembolism (VTE) in Europe. Thromb Haemost 98:756–764
Geerts WH, Bergqvist D, Pineo GF et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edn). Chest 133:381–453
Turpie AG, Bauer KA, Eriksson BI et al (2002) Fondaparinux vs enoxaparin for the preven tion of venous thromboembolism in major orthopedic surgery: a meta-analysis of 4 randomized double-blind studies. Arch Intern Med 162:1833–1840
Mismetti P, Laporte S, Zufferey P et al (2004) Prevention of venous thrombembolism in or thopedic surgery with vitamin K antagonists: a meta-analysis. J Thromb Haemost 2:1058–1070
Eikelboom JW, Quinlan DJ, Douketis JD (2001) Extended duration prophylaxis against ve nous thromboembolism after total hip or knee replacement: a meta-analysis of the random ized trials. Lancet 358:9–15
Weitz JI, Hirsh J, Samama MM (2008) New antithrombotic drugs: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 133:234–256
Eriksson BI, Dahl OE, Rosencher N et al (2007) Oral dabigatran etexilate versus subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J Thromb Haemost 5:2178–2185
Eriksson BI, Dahl OE, Rosencher N et al (2007) RE-NOVATE Study Group. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomized, double-blind, non-inferiority trial. Lancet 370:949–956
RE-MOBILIZE Writing Committee, Ginsberg JS, Davidson BL, Comp PC et al (2009) The oral thrombin inhibitor dabigatran etexilate vs the north american enoxaparin regimen for the prevention of venous thromboembolism after knee arthroplasty surgery. J Arthroplasty 2:1–9
European Medicines Agency (EMEA). European public assessment report: Pradaxa [online]. http://www.emea.europa.eu
Perzborn E, Strassburger J, Wilmen A et al (2005) In vitro and in vivo studies of the novel antithrombotic agent BAY 59-7939-an oral, direct Factor Xa inhibitor. J Thromb Haemost 3:514–521
Mueck W, Eriksson BI, Bauer KA et al (2008) Population pharmacokinetics and pharmacodynamics of rivaroxaban-an oral, direct factor Xa inhibitor-in patients undergoing major orthopaedic surgery. Clin Pharmacokinet 47:203–216
Eriksson BI, Borris LC, Friedman RJ et al (2008) Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med 358:2765–2775
Kakkar AK, Brenner B, Dahl OE et al (2008) Extended duration rivaroxaban versus shortterm enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet 372:31–39
Lassen MR, Ageno W, Borris LC et al (2008) Rivaroxaban for thromboprophylaxis after total knee arthroplasty. N Engl J Med 358:2776–2785
Turpie AGG, Bauer KA, Davidson B et al (2009) Once-daily oral rivaroxaban compared with subcutaneous enoxaparin every 12 hours for thromboprophylaxis after total knee replacement: RECORD4. Lancet 373:1673–180
Wirth T, Schneider B, Misselwitz F et al (2001) Prevention of venous thromboembolism after knee arthroscopy with low molecular weight heparin (Reviparin): results of a randomized controlled trial. Arthroscopy 17:393–399
Michot M, Conen D, Holtz D et al (2002) Prevention of deep vein thrombosis in ambulatory arthroscopic knee surgery: a randomized trial of prophylaxis with low molecular weight heparin. Arthroscopy 18:257–263
Camporese G, Bernardi E, Prandoni P et al (2008) Low-molecular-weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: a randomized trial. Ann Intern Med 149:73–82
Lapidus LJ, Rosfors S, Ponzer S et al (2007) Prolonged thromboprophylaxis with dalteparin after surgical treatment of Achilles tendon rupture: a randomized, placebo-controlled study. J Orthop Trauma 21:52–57
Lassen MR, Borris LC, Nakov RL (2002) Use of the low-molecular-weight heparin reviparin to prevent deep-vein thrombosis after leg injury requiring immobilization. N Engl J Med 347:726–730
Testroote M, Stigter W, de Visser DC et al (2008) Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization. Cochrane Database Syst Rev (4):CD006681
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag Italia
About this chapter
Cite this chapter
Ageno, W., Dentali, F., Squizzato, A. (2011). Thromboprophylaxis in Sports Injury. In: Margheritini, F., Rossi, R. (eds) Orthopedic Sports Medicine. Springer, Milano. https://doi.org/10.1007/978-88-470-1702-3_11
Download citation
DOI: https://doi.org/10.1007/978-88-470-1702-3_11
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-1701-6
Online ISBN: 978-88-470-1702-3
eBook Packages: MedicineMedicine (R0)