Date of Graduation

8-15-2009

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

James Ferguson, PA-C

Second Advisor

Annjanette Sommers MS, PA-C

Third Advisor

Rob Rosenow PharmD, OD

Abstract

Background: Deep vein thrombosis (DVT) or venous thromboembolus (VTE), is a common complication with orthopedic surgery and remains a serious problem even with multiple medications available for prophylaxis. Enoxaparin and fondaparinux are widely accepted in North America, Australia, and Europe although, a lack of evidence still remains to determine which is more effective in DVT prophylaxis in orthopedic surgery. This systematic review seeks to determine whether fondaparinux is more effective than enoxaparin in DVT prophylaxis.

Methods: A systematic literature search using multiple databases focusing on articles from professional journals, position statements, information from pharmaceutical manufacturers and CDC statistics were the primary sources for this study.

Hypothesis: Fondaparinux is more effective than enoxaparin in DVT prophylaxis, with a lower bleeding risk, and reduction of patient death.

Results: Six studies were evaluated to determine the effectiveness of fondaparinux compared to enoxaparin. Fondaparinux was compared to enoxaparin in double-blinded randomly assigned trials using subjects over 18 years of age who were scheduled to undergo orthopedic surgery of the lower extremity within 48 hours of admission. Potential subjects were excluded from the studies if they were involved in multiple trauma affecting more than one organ system, pregnancy, active bleeding, history of hemorrhagic stroke, bleeding disorder, hypersensitivity to heparin, serum creatinine above 2 mg/dl, and a platelet count below 100,000 per cubic millimeter. In all studies day 1 was defined as the day of surgery.

Conclusion: Fondaparinux is more effective at DVT prophylaxis than enoxaparin and should be considered a preferential agent in high DVT risk orthopedic surgery. Further randomized trials with long term outcomes (>30 days), are needed to evaluate benefit to risk of longer term prophylaxis post orthopedic surgery.

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