Nav: Home

Are blood thinners post-op killers?

March 31, 2008

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 paper (1) 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.
-end-
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).

The full-text article is available to journalists as a pdf.

Springer

Related Pulmonary Embolism Articles:

Short or long sleep associated with Pulmonary Fibrosis
Scientists have discovered that people who regularly sleep for more than 11 hours or less than 4 hours are 2-3 times more likely to have the incurable disease, pulmonary fibrosis, compared to those that sleep for 7 hours in a day.
Better way to interpret blood tests to diagnose pulmonary embolism
A study led by Hamilton researchers has found a new way to interpret blood test results in patients who are investigated for blood clots in their lungs, a condition known as pulmonary embolism.
Reversed halo signs manifest in septic pulmonary embolism due to IV drug use
According to an article published ahead-of-print in the January 2020 issue of the American Journal of Roentgenology (AJR), reversed halo signs were frequently observed on the chest CT scans of patients with IV substance use disorder-related septic pulmonary embolism.
Treating pulmonary embolism: How safe and effective are new devices?
A new scientific statement from the American Heart Association identifies the risks and benefits of novel interventional devices compared to anticoagulation alone in the treatment of patients with pulmonary embolism.
Promising steps towards a treatment for pulmonary fibrosis
Research published in the journal Science Translational Medicine on 25 September by members of the Cardiovascular Disease Mechanisms group at the MRC LMS in collaboration with Duke-NUS Medical School, National Heart Centre Singapore & National Heart and Lung Institute, Imperial College London, showed that blocking a protein called interleukin-11 (IL-11) using therapeutic antibodies can reverse the fibrosis in the lung.
African-Americans with COPD appear less likely to use pulmonary rehab
African-American patients with chronic obstructive pulmonary disease, or COPD, are less likely to participate in pulmonary rehabilitation programs than white patients, even when there are programs nearby.
Lung-on-a-chip simulates pulmonary fibrosis
New biotechnology reported in the journal Nature Communications could make testing potential medicine for pulmonary fibrosis, one of the most common and serious forms of lung disease, quicker and less expensive.
Study identifies new target for treatment of pulmonary hypertension
Inhibiting FoxM1 gene reverses disease process in animal models of pulmonary hypertension.
Pulmonary fibrosis caused by single transcription factor
Reduced FoxO3 activity reprograms connective tissue cells, triggering the disease.
Lung cancer triggers pulmonary hypertension
Nearly half of all advanced-stage lung cancer patients develop arterial pulmonary hypertension.
More Pulmonary Embolism News and Pulmonary Embolism Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Uncharted
There's so much we've yet to explore–from outer space to the deep ocean to our own brains. This hour, Manoush goes on a journey through those uncharted places, led by TED Science Curator David Biello.
Now Playing: Science for the People

#556 The Power of Friendship
It's 2020 and times are tough. Maybe some of us are learning about social distancing the hard way. Maybe we just are all a little anxious. No matter what, we could probably use a friend. But what is a friend, exactly? And why do we need them so much? This week host Bethany Brookshire speaks with Lydia Denworth, author of the new book "Friendship: The Evolution, Biology, and Extraordinary Power of Life's Fundamental Bond". This episode is hosted by Bethany Brookshire, science writer from Science News.
Now Playing: Radiolab

Dispatch 1: Numbers
In a recent Radiolab group huddle, with coronavirus unraveling around us, the team found themselves grappling with all the numbers connected to COVID-19. Our new found 6 foot bubbles of personal space. Three percent mortality rate (or 1, or 2, or 4). 7,000 cases (now, much much more). So in the wake of that meeting, we reflect on the onslaught of numbers - what they reveal, and what they hide.  Support Radiolab today at Radiolab.org/donate.