Monitoring for anti-Xa activity for prophylactic administration of Fondaparinux in patients with artificial joint replacement.
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The efficacy of measuring anti-Xa activity was evaluated in majororthopedic surgery patients receiving thrombo-prophylaxis withFondaparinux. Although 98 orthopedic patients including those receivingtotal hip replacement (THR) and total knee replacement (TKR), weretreated with 1.5 mg of Fondaparinux for prophylaxis of deep veinthrombosis (DVT). Sixteen patients developed DVT, but none wereassociated with a fatal pulmonary embolism. There was a wide range ofanti-Xa activity, but there were no patients with less than 0.15 mg/L ormore than 0.90 mg/L. Anti-Xa activity gradually increased from day 1 today 8 and showed no significant difference between patients with andwithout DVT. Anti-Xa activity was correlated with weight, height, bodymass index, and antithrombin activity. Postoperative plasma levels ofD-dimer and soluble (SF) were markedly high, and those were significantlyreduced at day 1 and 4 of treatment with Fondaparinux. Plasma levels of SF were significantly reduced at day 8 and 15, but D-dimer was not. Thesefindings suggested that there was continued thrombin generation after theinjection of Fondaparinux until day 8 and secondary fibrinolysis occurred on day 8. In conclusion, 1.5 mg of Fondaparinux may not be sufficient forthe prophylaxis of silent DVT, but it was found to be useful for that of fatalpulmonary embolism. Consequently, monitoring anti-Xa activity may beunnecessary for the administration of Fondaparinux at such doses.
- SPRINGER TOKYOの論文
- 2011-10-00
SPRINGER TOKYO | 論文
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