Ximelagatran, a new oral direct thrombin inhibitor, for the prevention of venous thromboembolic events in major elective orthopaedic surgery. Efficacy, safety and anaesthetic considerations
Open Access
- 19 July 2004
- journal article
- review article
- Published by Wiley in Anaesthesia
- Vol. 59 (8), 803-810
- https://doi.org/10.1111/j.1365-2044.2004.03840.x
Abstract
The oral direct thrombin inhibitor ximelagatran shows great promise for prevention of venous thromboembolic events following major elective orthopaedic surgery. Its consistent and predictable pharmacokinetics and pharmacodynamics across a wide range of patient populations allow administration with fixed dosing and with no coagulation monitoring. In orthopaedic surgery clinical trials, ximelagatran was effective and well tolerated compared with standard therapy, with dose and timing relative to surgery important factors in determining its optimal profile. In European trials, an initial 3-mg postoperative dose of subcutaneous melagatran, the active form of ximelagatran, followed by oral ximelagatran 24 mg twice daily achieved similar efficacy and safety to enoxaparin. Although the risk of spinal haematoma following neuraxial anaesthesia is rare, it is increased by the concomitant use of anticoagulants. In orthopaedic surgery trials with ximelagatran to date, complications such as spinal haematoma have not been reported. The pharmacokinetic profile of ximelagatran suggests that concurrent use with neuraxial anaesthesia should require no further precautions than those currently necessary with low-molecular-weight heparin.Keywords
This publication has 47 references indexed in Scilit:
- Timing of Initial Administration of Low-Molecular-Weight Heparin Prophylaxis Against Deep Vein Thrombosis in Patients Following Elective Hip ArthroplastyArchives of Internal Medicine, 2001
- Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomised trialsThe Lancet, 2001
- Extended Thromboprophylaxis with Low Molecular Weight Heparin Reduces Symptomatic Venous Thromboembolism following Lower Limb Arthroplasty - a Meta-analysisThrombosis and Haemostasis, 2001
- Prevention of Venous ThromboembolismChest, 2001
- Low-Molecular-Weight Heparin Prophylaxis Using Dalteparin in Close Proximity to Surgery vs Warfarin in Hip Arthroplasty PatientsArchives of Internal Medicine, 2000
- Past incidence and future demand for knee arthroplasty in Sweden: A report from the Swedish Knee Arthroplasty Register regarding the effect of past and future population changes on the number of arthroplasties performedActa Orthopaedica, 2000
- Oral AnticoagulantsChest, 1998
- Epidural Anesthesia and AnalgesiaAnesthesiology, 1995
- Interactions of Warfarin with Drugs and FoodAnnals of Internal Medicine, 1994
- Oral Anticoagulant DrugsNew England Journal of Medicine, 1991