Are blood thinners post-op killers?

April 01, 2008

New study shows that the use of powerful anticoagulants to prevent pulmonary embolism may actually lead to more deaths after surgery

Current US guidelines for the prescription of potent anticoagulants by surgeons who perform joint replacement operations could be doing patients more harm than good, according to Dr. Nigel Sharrock and his team from the Hospital for Special Surgery in New York. They argue for a revision of the American College of Chest Physicians' guidelines, in light of their review showing that the use of powerful anticoagulants to prevent pulmonary embolism may actually lead to more deaths among patients who take these drugs. The paper1 was published in the March issue of Springer's journal Clinical Orthopaedics and Related Research.

Anticoagulants are routinely prescribed before and after total hip and knee replacement operations to reduce the risk of thrombosis, and death from pulmonary embolism in particular, as recommended by the Chest Physicians Consensus Statement. During the last decades, deaths from pulmonary embolism have fallen significantly due to a combination of advancements in anesthesia, better surgical techniques and care pre- and post-surgery, as well as a better understanding of how thrombosis develops as a result of surgery. In light of these developments, Sharrock and his team looked at whether the prescription of potent anticoagulants by surgeons who perform joint replacement operations is still warranted, as these drugs also have side effects.

The authors reviewed 20 studies among a total of just over 28,000 patients undergoing joint replacement surgery who were prescribed medication to reduce the risk of thrombosis. They compared the total number of deaths and cases of non-fatal pulmonary embolism between three frequently used prevention protocols worldwide. Patients in group A received potent anticoagulants such as low molecular weight heparin; those in group B received local spinal or epidural anesthesia, pneumatic compression and aspirin; patients in group C were prescribed slow-acting oral anticoagulants such as warfarin.

The lowest number of deaths occurred in patients in group B. Patients in groups A and C were more than twice as likely to have died as those in group B. There was no difference in the number of deaths between groups A and C. Patients in group A were also at 60-70% greater risk of non-fatal pulmonary embolism than those in group B, indicating that pulmonary embolism occurs despite the use of powerful anticoagulants.

Sharrock and colleagues conclude that "the American College of Chest Physicians should reconsider their guidelines to reflect the fact that pulmonary embolism occurs despite the use of potent anticoagulants and may, in fact, expose patients to increased mortality after surgery." In their view, the current recommendations often result in physicians feeling compelled to prescribe these anticoagulants to avoid potential litigation when, in reality, these drugs could be doing more harm than good.

Reference
1. Sharrock NE et al (2008). Potent anticoagulants are associated with a higher all-cause mortality rate after hip and knee arthroplasty. Clin Orthop Relat Res; 466:714-721 (DOI 10.1007/s11999-007-0092-4).

Springer

---

---

	Anticoagulants, part I. (Drugs, Pregnancy, and Lactation).: An article from: Family Practice News by Gerald G. Briggs (Author) This digital document is an article from Family Practice News, published by International Medical News Group on July 15, 2002. The length of the article is 801 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser. Citation Details Title: Anticoagulants, part I. (Drugs, Pregnancy, and Lactation). Author: Gerald G. Briggs Publication: Family Practice News (Magazine/Journal) Date: July 15, 2002 Publisher: International Medical News Group Volume: 32 Issue: 14 Page: 23(1) Distributed by Thomson...
	Anticoagulants, Antiplatelets, and Thrombolytics (Methods in Molecular Biology) by Shaker A. Mousa (Editor) During the past decade, remarkable progress has been made in the development of newer drugs to prevent and treat thromboembolic disorders, such as oral direct anti-Xa and anti-IIa antagonists, as well as oral antiplatelet ADP antagonists with rapid onset and offset. In addition, there has been concentrated effort aimed at identifying novel uses of traditional antithrombotic drugs, such as aspirin, heparin, and oral anticoagulants, as well as combinations of agents, such as more than one antiplatelet, antiplatelet with anticoagulant, antiplatelet with or without thrombolytic. Anticoagulants, Antiplatelets, and Thrombolytics, Second Edition provides updates on various strategies in thrombosis, experimental models, and clinical and recent advances in the discovery and development of novel...
	Hypercoagulable States and New Anticoagulants, An Issue of Hematology/Oncology Clinics of North America, 1e (The Clinics: Internal Medicine) by Mark Crowther MD MSc FRCPC (Author), Marco Donadini MD (Author) This issue addresses hypercoagulable states, such as antiphospholipid antibody syndrome, cancer-associated thrombosis, and coagulopathy associated with sepsis.  New anticoagulants discussed include oral Xa inhibitors, oral IIa inhibitors, agents for the treatment of HIT, and use of low molecular weight heparin to improve survival in cancer patients.
	Anticoagulants: Webster's Timeline History, 1914 - 2006 by Icon Group International (Author) Webster's bibliographic and event-based timelines are comprehensive in scope, covering virtually all topics, geographic locations and people. They do so from a linguistic point of view, and in the case of this book, the focus is on "Anticoagulants," including when used in literature (e.g. all authors that might have Anticoagulants in their name). As such, this book represents the largest compilation of timeline events associated with Anticoagulants when it is used in proper noun form. Webster's timelines cover bibliographic citations, patented inventions, as well as non-conventional and alternative meanings which capture ambiguities in usage. These furthermore cover all parts of speech (possessive, institutional usage, geographic usage) and contexts, including pop culture, the arts,...
	Anticoagulants: Webster's Timeline History, 2007 by Icon Group International (Author) Webster's bibliographic and event-based timelines are comprehensive in scope, covering virtually all topics, geographic locations and people. They do so from a linguistic point of view, and in the case of this book, the focus is on "Anticoagulants," including when used in literature (e.g. all authors that might have Anticoagulants in their name). As such, this book represents the largest compilation of timeline events associated with Anticoagulants when it is used in proper noun form. Webster's timelines cover bibliographic citations, patented inventions, as well as non-conventional and alternative meanings which capture ambiguities in usage. These furthermore cover all parts of speech (possessive, institutional usage, geographic usage) and contexts, including pop culture, the arts,...
	The 2009-2014 World Outlook for Anticoagulant Pharmaceutical Preparations by Icon Group (Author) This econometric study covers the world outlook for anticoagulant pharmaceutical preparations across more than 200 countries. For each year reported, estimates are given for the latent demand, or potential industry earnings (P.I.E.), for the country in question (in millions of U.S. dollars), the percent share the country is of the region and of the globe. These comparative benchmarks allow the reader to quickly gauge a country vis-à-vis others. Using econometric models which project fundamental economic dynamics within each country and across countries, latent demand estimates are created. This report does not discuss the specific players in the market serving the latent demand, nor specific details at the product level. The study also does not consider short-term cyclicalities that...
	The 2010-2015 World Outlook for Anticoagulants by Icon Group International (Author) This econometric study covers the world outlook for anticoagulants across more than 200 countries. For each year reported, estimates are given for the latent demand, or potential industry earnings (P.I.E.), for the country in question (in millions of U.S. dollars), the percent share the country is of the region and of the globe. These comparative benchmarks allow the reader to quickly gauge a country vis-a-vis others. Using econometric models which project fundamental economic dynamics within each country and across countries, latent demand estimates are created. This report does not discuss the specific players in the market serving the latent demand, nor specific details at the product level. The study also does not consider short-term cyclicalities that might affect realized sales. The...
	Anticoagulant: Webster's Timeline History, 1914 - 2007 by Icon Group International (Author) Webster's bibliographic and event-based timelines are comprehensive in scope, covering virtually all topics, geographic locations and people. They do so from a linguistic point of view, and in the case of this book, the focus is on "Anticoagulant," including when used in literature (e.g. all authors that might have Anticoagulant in their name). As such, this book represents the largest compilation of timeline events associated with Anticoagulant when it is used in proper noun form. Webster's timelines cover bibliographic citations, patented inventions, as well as non-conventional and alternative meanings which capture ambiguities in usage. These furthermore cover all parts of speech (possessive, institutional usage, geographic usage) and contexts, including pop culture, the arts, social...
	New Anticoagulants for the Cardiovascular Patient, 1e by Roque Pifarre MD MSc FACS FRCS(C) (Author) This volume provides coverage of new anticoagulants, with particular reference to cardiovascular surgery.
	Anticoagulant Therapy FAQs: A Guide to Compliance with National Patient Safety Goal 3E by Content from transcribed audio conference./HR (Author) Are you ready to comply with The Joint Commission s new anticoagulant therapy National Patient Safety Goal? Patient safety professionals have plenty of questions about how to comply with The Joint Commission s National Patient Safety Goal (NPSG) 3E on anticoagulant therapy, from big-picture concerns about compliance to detailed queries about specific anticoagulant drugs and protocols. And here are the answers. Anticoagulant Therapy FAQs: A Guide to Compliance with National Patient Safety Goal 3E is a question-and-answer guide to help you comply with the goal. Actual questions from your peers are answered by industry experts to help ease confusion and walk you through the phase-in period to full implementation by January 2009. Your copy of Anticoagulant Therapy FAQs: Answers...