Ortho Oracle - orthopaedic operative atlas

References: XARELTO (rivaroxaban)

NICE recommends rivaroxaban (XARELTO®) to prevent blood clots in people who have had a heart attack – NICE 3/25/15 Bayer discloses encouraging data on anticoagulant XARELTO® Bayer happy with rivaroxaban (XARELTO®) trial results Efficacy and safety of rivaroxaban versus low-molecular-weight heparin therapy in patients with lower limb fractures. A non-interventional comparison of rivaroxaban with standard … Read more

Deep Venous Thrombosis (DVT) – Ultrasound

Discussion allows assessment of DVT from the external iliac vein down to the popliteal veins visualization distal to the popliteal veins is usually not possible may be able to detect patency of major vessels, but it is not effective for smaller vessels will not diagnose pelvic thrombi note that clots seen on ultrasound comprise a … Read more

Treatment of DVT and PE

Clinical Cardiology: Diagnosis, Treatment, and Prevention of Pulmonary Embolism: Report of the WHO/International Society and Federation of Cardiology Task Force. Subcutaneous low-molecular-weight heparin compared with continuous intravenous heparin in the treatment of proximal-vein thrombosis. Heparin for 5 days as compared with 10 days in the initial treatment of proximal venous thrombosis. Is anticoagulation indicated for asymptomatic postoperative … Read more

Deep Venous Thrombosis (DVT) – Treatment

Indications for treatment proximal DVT proximal propagation of a distal DVT some authors advocate that isolated asymptomatic distal DVT can be followed on serial Duplex Ultra-sound, and does not require treatment distal DVT will propagate proximally in less than 10-20% of cases, and has a low risk of PE serial ultrasound can be performed on … Read more

DVT Risk Reduction – Trauma, Pelvic Fractures, and Extremity Fractures

Prevention:      – coumadin, low molecular weight dextran, adjusted dose heparin, or low molecular weight heparin are proven effective for patients undergoing elective surgery Low Risk Trauma Patients w/ Lower Extremity Fracture:       – prophylaxis may be considered for patients with risk factors (female, obese, birth control, smoking ect).       – references:    … Read more

DVT Risk Reduction – TKA

Specific agents aspirin  heparin agents: (see low molecular wt agents) in TKA, w/ low molecular wt heparins relative risk reduction of DVT is about 50% controversies in the report by Comp, et al., the authors evaluated the efficacy and safety of a prolonged post-hospital regimen of enoxaparin following elective total hip or knee replacement, 968 … Read more

DVT Treatment – Thrombolytics

Tenecteplase (TNKase) modified version of alteplase with longer half-life, so it can be given as a single bolus over 5-second infusion availability – 10 mL syringe indication (non-comprehensive) reduce mortality associated with acute myocardial infarction Urokinase (Abbokinase) used clinically as a thrombolytic agent, often referred to as a “blood clot buster” drug availability – in … Read more

DVT Risk Reduction – THA

When should prophylaxis be initiated? in the review article by Salvati, et al., the authors point out that timing of heparin administration may be critcal for DVT prophylaxis they point out that thrombogenesis begins during the preparation of the femur and is most pronounced with implantation of femoral components with cement rather than without cement … Read more

Deep Venous Thrombosis (DVT) – Risk Reduction

Procedure-specific risk reduction THA TKA trauma, pelvic fractures, and extremity fractures hip fracture Specific agents for risk reduction apixaban (oral factor Xa inhibitor) Apixaban for Extended Treatment of Venous Thromboembolism aspirin  (see role of ASA for DVT prophylaxsis) danaparoid low molecular wt glycosaminoglycan with potent anti factor Xa activity fondaparinux low molecular weight heparins may … Read more