In this Cochrane meta-analysis, researchers analyzed the overall efficacy and safety of direct thrombin inhibitors, compared to warfarin or LMWH, in preventing VTE after orthopedic surgeries (hip and knee arthroplasty). In14 studies involving over 20,000 participants, they found no difference in efficacy between direct thrombin inhibitors, warfarin, or LMWH, but did find higher mortality and bleeding in the thrombin group compared to LMWH (but no difference between the thrombin group and warfarin) (abstract). The timing of the thrombin inhibitors also matters, as pre-operative dosing results in fewer VTE’s but likely higher bleeding. Dabigatran is the oral direct thrombin inhibitor that is currently approved in Canada and throughout Europe, but US FDA approval is pending.
I am coming up on my two year anniversary. Not my wedding anniversary (soon to be 15 years – thanks Maia!), but two years since I joined the ranks of the patients. It was two years ago this week that my day was interrupted by a page from my internist saying, “I don’t know how […]
As you can see, no glamour shots for this month’s post. I knew it would come at some point, and my first hospitalization related to my CLL came in a big way in mid-July. Given my interest in global health, it was only fitting that I managed to get sick while out of the […]
This large multicenter trial randomized patients with acute VTE to apixaban (10mg BID for 1 week, followed by 5mg BID for 6 months) versus conventional therapy (lovenox-warfarin). The primary outcome was similar between groups (symptomatic VTE or death related to VTE), but major and minor bleeding occurred significantly less often with apixaban. Apixaban is a […]