Taking the Shots out of Orthopedic Surgery

As anyone who’s had knee or hip replacement surgery knows, post-op recovery can be long and painful. There’s the learning to walk again, the physical therapy and the dreaded daily injections in the belly.

While great strides have been made in surgery for degenerative joint disease, preventing post-op complications such as deep vein thrombosis (DVT) and pulmonary embolism (PE) remains problematic. Conventional antithrombotic agents (heparin and low-molecular-weight heparin) have to be given by injection into fatty subcutaneous tissue, usually into the leg or abdomen, for days or weeks after surgery and discharge from the hospital. Not surprisingly, acceptance of, and compliance with, thromboembolic prophylaxis is limited by the need for injections, the bruising and associated risks for bleeding.

Now it seems the days are numbered for injection therapy.  A recent meta-analysis of 22 randomized trials comparing oral factor Xa inhibitors with low-molecular-weight heparin injections in adults who underwent total hip or knee replacement has just been published in the Annals of Internal Medicine.

The results showed that new generation oral antithrombotic agents, including apixaban, edoxaban, and rivaroxaban, that do not require monitoring, actually led to fewer symptomatic deep venous thrombosis.

Furthermore, there was no difference between the groups in terms of mortality, non-fatal PE, major bleeding, or bleeding leading to reoperation. The study authors therefore predict that these oral agents will likely replace low-molecular-weight heparins.

As a likely candidate for future joint replacement, thanks to a family history of osteoarthritis, and joints wrecked by years of gymnastics and running, I for one am very grateful.

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