PMID- 37606428
OWN - NLM
STAT- MEDLINE
DCOM- 20230823
LR  - 20230924
IS  - 2076-3271 (Electronic)
IS  - 2076-3271 (Linking)
VI  - 11
IP  - 3
DP  - 2023 Aug 11
TI  - Venous Thromboembolism Prophylaxis in Major Orthopedic Surgeries and Factor XIa 
      Inhibitors.
LID - 10.3390/medsci11030049 [doi]
LID - 49
AB  - Venous thromboembolism (VTE), comprising pulmonary embolism (PE) and deep vein 
      thrombosis (DVT), poses a significant risk during and after hospitalization, 
      particularly for surgical patients. Among various patient groups, those 
      undergoing major orthopedic surgeries are considered to have a higher 
      susceptibility to PE and DVT. Major lower-extremity orthopedic procedures carry a 
      higher risk of symptomatic VTE compared to most other surgeries, with an 
      estimated incidence of ~4%. The greatest risk period occurs within the first 7-14 
      days following surgery. Major bleeding is also more prevalent in these surgeries 
      compared to others, with rates estimated between 2% and 4%. For patients 
      undergoing major lower-extremity orthopedic surgery who have a low bleeding risk, 
      it is recommended to use pharmacological thromboprophylaxis with or without 
      mechanical devices. The choice of the initial agent depends on the specific 
      surgery and patient comorbidities. First-line options include 
      low-molecular-weight heparins (LMWHs), direct oral anticoagulants, and aspirin. 
      Second-line options consist of unfractionated heparin (UFH), fondaparinux, and 
      warfarin. For most patients undergoing knee or hip arthroplasty, the initial 
      agents recommended for the early perioperative period are LMWHs (enoxaparin or 
      dalteparin) or direct oral anticoagulants (rivaroxaban or apixaban). In the case 
      of hip fracture surgery, LMWH is recommended as the preferred agent for the 
      entire duration of prophylaxis. However, emerging factor XI(a) inhibitors, as 
      revealed by a recent meta-analysis, have shown a substantial decrease in the 
      occurrence of VTE and bleeding events among patients undergoing major orthopedic 
      surgery. This discovery poses a challenge to the existing paradigm of 
      anticoagulant therapy in this specific patient population and indicates that 
      factor XI(a) inhibitors hold great promise as a potential strategy to be taken 
      into serious consideration.
FAU - Jones, Aaryana
AU  - Jones A
AD  - Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University 
      of Louisiana, New Orleans, LA 70125, USA.
FAU - Al-Horani, Rami A
AU  - Al-Horani RA
AUID- ORCID: 0000-0001-9146-2662
AD  - Division of Basic Pharmaceutical Sciences, College of Pharmacy, Xavier University 
      of Louisiana, New Orleans, LA 70125, USA.
LA  - eng
GR  - R16 GM149412/GM/NIGMS NIH HHS/United States
GR  - SC3 GM131986/GM/NIGMS NIH HHS/United States
GR  - R16GM149412/GM/NIGMS NIH HHS/United States
GR  - SC3GM131986/GM/NIGMS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Review
DEP - 20230811
PL  - Switzerland
TA  - Med Sci (Basel)
JT  - Medical sciences (Basel, Switzerland)
JID - 101629322
RN  - EC 3.4.21.27 (Factor XIa)
RN  - 0 (Anticoagulants)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Humans
MH  - Factor XIa
MH  - Anticoagulants/therapeutic use
MH  - *Venous Thromboembolism/prevention & control
MH  - Heparin, Low-Molecular-Weight
MH  - Heparin
MH  - *Arthroplasty, Replacement, Hip
MH  - *Arthroplasty, Replacement, Knee
MH  - *Pulmonary Embolism
PMC - PMC10443384
OTO - NOTNLM
OT  - LMWHs
OT  - VTE
OT  - abelacimab
OT  - aspirin
OT  - factor XIa
OT  - milvexian
OT  - oral anticoagulants
OT  - orthopedic
OT  - osocimab
OT  - thromboprophylaxis
COIS- The authors declare no conflict of interest. The funders had no role in the 
      design of the study; in the collection, analyses, or interpretation of data; in 
      the writing of the manuscript; or in the decision to publish the results.
EDAT- 2023/08/22 13:42
MHDA- 2023/08/23 06:42
PMCR- 2023/08/11
CRDT- 2023/08/22 09:14
PHST- 2023/06/12 00:00 [received]
PHST- 2023/07/26 00:00 [revised]
PHST- 2023/08/09 00:00 [accepted]
PHST- 2023/08/23 06:42 [medline]
PHST- 2023/08/22 13:42 [pubmed]
PHST- 2023/08/22 09:14 [entrez]
PHST- 2023/08/11 00:00 [pmc-release]
AID - medsci11030049 [pii]
AID - medsci-11-00049 [pii]
AID - 10.3390/medsci11030049 [doi]
PST - epublish
SO  - Med Sci (Basel). 2023 Aug 11;11(3):49. doi: 10.3390/medsci11030049.