Published: 2016-12-29

The role of newer anticoagulants in prevention of deep vein thrombosis following joint replacements

Anandha Prabu, Jambu N., Ganesh Babu


Background: Deep vein thrombosis following orthopedic surgeries particularly hip and knee arthroplasty is due to the accompanying blood vessel trauma, venous stasis, coagulation activation and older age in most of the patients. This study aims to study the efficacy of newer anticoagulants such as direct thrombin and direct factor Xa inhibitors in prevention of deep vein thrombosis (DVT) following arthroplasties.

Methods: Tablet Apixaban 2.5 mg twice daily was administered for 15 days following total knee replacement (TKR) and 30 days following total hip replacement (THR) or hemiarthroplasties.  Patients were examined clinically and radiologically with colour doppler of both lower limbs from 5th-13th and 30th-42th day postoperatively during follow up.

Results: Only 3 out of 53 patients who underwent hip/knee arthroplasty developed DVT (p <0.05) which were found to be significant.

Conclusions: The prevention of DVT in hip and knee arthoplasty using newer anticoagulant Apixaban was more efficacious, well tolerated with low rate of bleeding.


Deep vein thrombosis, Hip and knee arthoplasty, Apixaban

Full Text:



Heit JA, Cohen AT, Anderson FA. Estimated annual numberincident and recurrent, non-fatal and fatal venous thromboembolism (VTE)events in the US. ASH Annual Meeting Abstracts. 2005;106(11):910.

Hirsh J, Donnell MO, Eikelboom JW. Beyond unfractionated heparin and warfarin: current and future advances. Circulation. 2007;116(5):552-60.

Dillon KS, Ashanker A, Doraisamy S. Postoperative deep vein thrombosis in Asian patients is not a rarity. JBJS (Br). 1996:78(3):427-9.

Handley AJ, Emerson PA, Fleming PR. Heparin in the prevention of deep vein thrombosis after myocardial infarction. Br Med J. 1972;7:436.

Burkit DP. Varicose veins, deep vein thrombosis and hemorrhoids. Epidemiology and suggested etiology. Br Med J. 1972;2;556.

Murthy SSR, Rao PLNG, Sodhi JS. Postoperative deep vein thrombosis. J Asso Phy Ind. 1979;27:239-45.

Adis International. Increased Need for Thromboprophylaxis in older Orthopaedic surgery patients. Drug and Ther Perspect. 2000;16(8):12-6.

Bjornara BT, Godmundsen TE, Dahl OE. Frequency and timing of clinical venous thromboembolism after major surgery. J Bone Joints (Br). 2006;88:386-91.

Rajagopalan N. Thromboprophylaxis by dalheparin sodium in elective major orthopaedic surgery. Indian J Orthop. 2003;37(2):94-7.

Pearse EO, Caldwell BF, Lockwood RJ, Hollard J. Early mobilization and conventional knee replacement may redce the risk of postoperative venous thromboembolism. J bone Joint Surg [Br]. 2007;89:316-22.