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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 11  |  Issue : 1  |  Page : 73

Chemoprophylaxis for deep vein thrombosis after hip surgery: Clinical guidelines and treatment options


1 Department of Rehabilitation Medicine, Singapore General Hospital, Singapore
2 Department of Pharmacy, Singapore General Hospital, Singapore

Date of Web Publication19-Aug-2019

Correspondence Address:
Dr. Tan Yeow Leng
Singapore General Hospital, Outram Road, 169608
Singapore
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jotr.jotr_20_19

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How to cite this article:
Leng TY, Yin LJ. Chemoprophylaxis for deep vein thrombosis after hip surgery: Clinical guidelines and treatment options. J Orthop Traumatol Rehabil 2019;11:73

How to cite this URL:
Leng TY, Yin LJ. Chemoprophylaxis for deep vein thrombosis after hip surgery: Clinical guidelines and treatment options. J Orthop Traumatol Rehabil [serial online] 2019 [cited 2019 Nov 22];11:73. Available from: http://www.jotr.in/text.asp?2019/11/1/73/264721



Sir,

The recent publication by Pal et al. titled, “Chemoprophylaxis for deep vein thrombosis (DVT) after hip surgery: The Indian prospective” has caught our attention.[1] We will like to take this opportunity to give comments pertaining to chemoprophylaxis after major orthopedic surgery.

There is a need to recognize that guidelines exist for the duration of chemoprophylaxis after hip surgery. Commonly cited guidelines include American College of Clinical Pharmacy, American Academy of Orthopedic Surgeons, Scottish Intercollegiate Guidelines Network, and the National Institute for Health and Care Excellence.[2] For elective surgery such as total hip replacement, optimal duration of prophylaxis recommended range from 10 to 14 days for enoxaparin. For hip fractures undergoing surgery, the length of enoxaparin treatment varies from at least 10 to 14 days and up to 35 days to 4 weeks. In this study by Pal et al., the duration of enoxaparin prophylaxis was 7 days in Group 1 cohort. It was unclear why the authors chose 7 days of enoxaparin treatment in their methodology. However, we do agree that early commencement of enoxaparin postoperatively leads to significant reduction in DVT incidence. Future prospective study should consider available established guidelines when deciding optimal prophylaxis duration.

Second, newer oral anticoagulants can be considered for chemoprophylaxis for certain hip and knee surgery.[3],[4] Drugs such as rivaroxaban, dabigatran, and apixaban have the advantage of fixed dosing without the need for blood monitoring. Use of these newer anticoagulants has gained increasing recognition in elective total hip or knee replacement, but use in hip fracture surgery is still lacking in evidence. At present, there are already studies on newer anticoagulants following hip fracture.[2],[5] More upcoming clinical research using newer oral anticoagulants in hip fracture surgery is expected. Clinicians should, therefore, have an up-to-date knowledge of new treatment options in this field.

In summary, this article has provided readers with insightful data on DVT incidence and prophylaxis in India. DVT after hip surgery is a common clinical problem. Clinicians should be aware of guidelines for DVT chemoprophylaxis and various recommendations for subgroups of orthopedic conditions. Moreover, new pharmacological agents are being studied for their clinical use for DVT prophylaxis and this will have relevant influence on clinical practice. There is a need for practitioners to constantly keep track of newly revised guidelines pertaining to chemoprophylaxis. We congratulate Pal et al. for their excellent research in this clinically important field.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pal CP, Shakunt RK, Altaf D, Hussain A, Deshwar G, Sharma YK. Chemoprophylaxis for deep vein thrombosis after hip surgery: The Indian prospective. J Orthop Traumatol Rehabil 2018;10:90-3.  Back to cited text no. 1
  [Full text]  
2.
Flevas DA, Megaloikonomos PD, Dimopoulos L, Mitsiokapa E, Koulouvaris P, Mavrogenis AF, et al. Thromboembolism prophylaxis in orthopaedics: An update. EFORT Open Rev 2018;3:136-48.  Back to cited text no. 2
    
3.
Eriksson BI, Borris LC, Friedman RJ, Haas S, Huisman MV, Kakkar AK, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med 2008;358:2765-75.  Back to cited text no. 3
    
4.
Kakkar AK, Brenner B, Dahl OE, Eriksson BI, Mouret P, Muntz J, et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: A double-blind, randomised controlled trial. Lancet 2008;372:31-9.  Back to cited text no. 4
    
5.
Jauegui RJ, Monzon DG, Iserson K, Musso CG, Casteulani AC, Schvarztein S. Thromboprophylaxis following hip fracture: A multicenter comparative study of dabigatran versus enoxaparan. SMJ Orthop 2016;5:1046.  Back to cited text no. 5
    




 

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