Drug library to have a lower incidence of major bleeding than warfarin, in the event of catastrophic hemorrhage no effective reversal agent exists. Neurosurgeons are likely to encounter this clinical scenario more frequently with the increased use of dabigatran and other similar drugs. Preclinical and early clinical trials have thus far failed to yield an effective reversal agent for these medications, and new treatments are certainly needed. The authors stress that a high index of suspicion for catastrophic taurine inhibitor hemorrhage isaily had a lower rate of intracranial hemorrhage when compared with warfarin, while a higher dose had a similar rate. Additionally, the higherdose dabigatran was superior to warfarin in the annual rate of stroke and systemic embolism. Postulated to by Total hip replacement is classified as at high thrombosis risk. American and French consensus conferences recommended prolonged 35 42 days thromboprophylaxis following THR.
In France, this has been implemented by injection of low glycyrrhetin 471-53-4 molecular weight heparin, with twice weekly platelet monitoring due to the risk of heparin induced thrombopenia. The only oral anticoagulant available was anti vitamin K, compliance could be checked on the International Normalized Ratio. However, difficulty of use, narrow implementation window and risk of hemorrhage, mainly due to misuse, led to AVK being abandoned in most cases as a preventive treatment for postoperative thrombosis in orthopedic surgery. Recently, new oral anticoagulants have come onto the market: dabigatran etexilate, an anti IIa, and rivaroxaban, an anti Xa, with official approval for prescription following THR and total knee replacement. Apixaban, an anti Xa, is to come onto the market soon. They are administered orally and do not require blood tests. In addition to comfort for the patient, who no longer undergoes fludarabine daily injection and weekly blood sampling, cost saving is also significant. These oral anticoagulants raise the issue of compliance for the medical community, as their administration is entirely the responsibility of the patient after discharge home. The present study therefore sought to assess compliance to oral thromboprophylaxis following THR and the possible consequences of non compliance.
The hypothesis was that compliance is good throughout the treatment prescribed for non dependent patients discharged home. Patients and method Patients A prospective continuous cohort study, with university funding and ethics committee approval, included patients undergoing first line THR in the Caen University Hospital Center between November 2, 2009 and July 28, 2010 and stroke receiving oral dabigatran etexilate, at a single dose of two 110 mg capsules per day. Other inclusion criteria were: age 18 75 years, and consent following written and oral information. Exclusion criteria were: discharge to another institution, previous long course anticoagulant treatment, low dabigatran etexilate dose indicated according to the marketing authorization, liver enzyme level more than 2 fold normal threshold, weight less than 50 kg, patient under amiodarone or quinidine, or adult patient under guardianship. Methods Thromboprophylaxis was initiated toward the end of the day of the THR. The study as such began at discharge, for 30 5 days to S30 5.
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