Mayer Adriane, Schuster Philipp, Fink Bernd
Department for Anaesthesiology, Orthopaedic Clinic Markgröningen, Kurt-Lindemann-Strasse 10, 71706, Markgröningen, Germany.
Department for Sports Medicine, Orthopaedic Clinic Markgröningen, Markgröningen, Germany.
Arch Orthop Trauma Surg. 2017 Jun;137(6):797-803. doi: 10.1007/s00402-017-2697-8. Epub 2017 Apr 24.
Patients who have undergone hip or knee replacement surgery are exposed to a high risk of developing a post-operative venous thromboembolus and so have a need for an effective, medication-based, thrombosis prophylaxis. New orally active anticoagulants have been available for a few years now. These specific substances directly block either thrombin (e.g., dabigatran etexilate) or Factor Xa (e.g., apixaban). It is not clear whether there are any efficacy differences between these two substances because there have never been any head-to-head studies carried out.
We have carried out a study comparing two new orally active anticoagulants dabigatran etexilate (Pradaxa) and apixaban (Eliquis) that were each given to two groups of 200 patients respectively, who had undergone elective hip or knee arthroplasty (100 each). Each patient was assessed for pre- and post-operative hemoglobin concentrations, post-operative blood loss, the number of transfused erythrocyte concentrates, the duration of wound secretion, clinical thromboembolic complications (deep vein thrombosis, pulmonary embolism, myocardial infarct), as well as gastrointestinal, intracranial or wound-related bleeding complications.
Dabigatran etexilate treatment led to a significant increase in the duration of wound secretion in both arthroplasty groups when compared to apixaban: wound secretion lasted 1.2 days longer on average in the dabigatran etexilate group than in the apixaban group (4.1 ± 2.1 vs. 2.9 ± 1.8 days). There were no significant differences observed between the two anticoagulant groups when comparing pre- and post-operative Hb values, post-operative blood loss and the other clinical parameters.
Thus, it appears that the direct thrombin inhibitor, dabigatran etexilate, is associated with a longer period of wound secretion following the implantation of hip and knee endoprostheses than that associated with the Factor Xa inhibitor, apixaban.
接受髋关节或膝关节置换手术的患者术后发生静脉血栓栓塞的风险很高，因此需要一种有效的、基于药物的血栓预防措施。新型口服活性抗凝剂已上市数年。这些特定物质可直接阻断凝血酶（如达比加群酯）或Xa因子（如阿哌沙班）。由于从未进行过直接对比研究，目前尚不清楚这两种物质在疗效上是否存在差异。
我们开展了一项研究，比较两种新型口服活性抗凝剂——达比加群酯（Pradaxa）和阿哌沙班（Eliquis），分别给予两组各200例接受择期髋关节或膝关节置换术的患者（每组100例）。对每位患者评估术前和术后血红蛋白浓度、术后失血量、输注红细胞浓缩液的数量、伤口分泌物持续时间、临床血栓栓塞并发症（深静脉血栓形成、肺栓塞、心肌梗死）以及胃肠道、颅内或伤口相关出血并发症。
与阿哌沙班相比，达比加群酯治疗导致两个置换术组的伤口分泌物持续时间均显著延长：达比加群酯组的伤口分泌物平均持续时间比阿哌沙班组长1.2天（4.1±2.1天对2.9±1.8天）。比较两组抗凝剂治疗前后的血红蛋白值、术后失血量和其他临床参数时，未观察到显著差异。
因此，与Xa因子抑制剂阿哌沙班相比，直接凝血酶抑制剂达比加群酯在髋关节和膝关节假体植入后似乎与更长的伤口分泌物持续时间相关。
