Evaluation of the anticoagulant effects of low molecular weight heparin calcium and fondaparinux sodium after intertrochanteric fractures surgery by combining thromboelastography_West China Medical Journal

Authors：

GONG Dezhi , XU Shengxi , LIU Dahai , Teng Lin ,  GOU Yongsheng

Department of Orthopedics, the first People’s Hospital of Shuangliu District / West China (Airport) Hospital Sichuan University, Chengdu, Sichuan 610200, P. R. China;

Corresponding?author：

GOU Yongsheng, Email: 19934439464@163.com

Keywords：

Thromboelastography; intertrochanteric fracture; low molecular weight heparin calcium; fondaparinux sodium; deep vein thrombosis

DOI：

10.7507/1002-0179.202501192

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Objective To evaluate the anticoagulant effects of low molecular weight heparin calcium versus fondaparinux sodium (FPX) after intertrochanteric fracture surgery using thromboelastography (TEG). Methods The patient who was hospitalized at the First People’s Hospital of Shuangliu District, requiring surgical intervention for intertrochanteric fracture was selected between September 2020 and September 2022. By using a random number table grouping method, the included patients were divided into the FPX group and the low molecular weight heparin calcium group. All patients underwent TEG was performed after admission, and on postoperative days 1, 3, and 7, and color doppler ultrasound of the lower limb vessels was conducted after admission and on postoperative day 7. The occurrence of deep vein thrombosis and TEG indicators were compared between the two groups. Results A total of 80 patients were included, with 40 patients in each group. There was no statistically significant difference in age, gender, and body mass index between the two groups (P>0.05). There was no statistically significant difference in the incidence of DVT between the FPX group and the low molecular weight heparin calcium group before surgery (9 vs. 7 cases) and after surgery (4 vs. 8 cases) (P>0.05). The fondaparinux group demonstrated a significantly higher K value compared to the low molecular weight heparin calcium group (P<0.05). Conversely, the MA value and CI value in the fondaparinux group were significantly lower than those in the low molecular weight heparin calcium group (P<0.05). There was no statistically significant difference in the other TEG parameters between the two groups (P>0.05). Conclusion The TEG findings suggest that the anticoagulant effect of FPX is more effective than that of low molecular weight heparin calcium following surgical treatment of intertrochanteric fractures.

1.	Lyew MA, Isaacson IJ. Template for rapid analysis of the thromboelastogram. Anesth Analg, 1992, 74(5): 782-783.
2.	Yang Y, Yao Z, Dai W, et al. Changes of thromboelastography in patients undergoing elective primary total knee and total hip replacement with low molecular heparin prophylaxis. J Orthop Surg Res, 2014, 9: 52.
3.	Xu X, Jiang J, Liu W, et al. Application of thromboelastography to evaluate the effect of different routes administration of tranexamic acid on coagulation function in total hip arthroplasty. J Orthop Surg Res, 2019, 14(1): 430.
4.	Gurunathan U, Stanton LM, Weir RM, et al. A preliminary study using rotational thromboelastometry to investigate perioperative coagulation changes and to identify hypercoagulability in obese patients undergoing total hip or knee replacement. Anaesth Intensive Care, 2019, 47(5): 461-468.
5.	呂波, 薛鋒, 唐果, 等. 下肢骨折后深靜脈血栓形成的影響因素分析. 國際骨科學雜志, 2018, 39(6): 373-377.
6.	Lim TK, Koh KH, Lee SH, et al. Inferior anchor cortical perforation with arthroscopic bankart repair: a cadaveric study. Arthroscopy, 2013, 29(1): 31-36.
7.	Fei C, Wang PF, Qu SW, et al. Deep vein thrombosis in patients with intertrochanteric fracture: a retrospective study. Indian J Orthop, 2020, 54(Suppl 1): 101-108.
8.	Niu S, Li J, Zhao Y, et al. Preoperative deep venous thrombosis (DVT) after femoral neck fracture in the elderly, the incidence, timing, location and related risk factors. BMC Musculoskelet Disord, 2021, 22(1): 264.
9.	中華醫學會臨床藥學分會《磺達肝癸鈉藥學實踐專家共識》編寫工作組. 磺達肝癸鈉藥學實踐專家共識. 醫藥導報, 2022, 41(11): 1571-1581.
10.	Sun G, Wu J, Wang Q, et al. Factor Ⅹa inhibitors and direct thrombin inhibitors versus low-molecular-weight heparin for thromboprophylaxis after total hip or total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty, 2019, 34(4): 789-800. e6.
11.	Bala A, Huddleston JI 3rd, Goodman SB, et al. Venous thromboembolism prophylaxis after tka: aspirin, warfarin, enoxaparin, or factor Ⅹa inhibitors?. Clin Orthop Relat Res, 2017, 475(9): 2205-2213.
12.	Yang T, Liu Z, Zhang B, et al. Comparison of the efficacy of low-molecular-weight heparin and fondaparinux sodium after total knee arthroplasty: a retrospective cohort study. BMC Musculoskelet Disord, 2023, 24(1): 552.
13.	徐厚圍. 磺達肝癸鈉與低分子肝素在老年髖部骨折中預防深靜脈血栓的療效比較. 南充: 川北醫學院, 2023.
14.	Kwong LM. Hip fracture and venous thromboembolism in the elderly. J Surg Orthop Adv, 2004, 13(3): 139-148.
15.	Eriksson BI. Improvements in the prevention of postoperative venous thromboembolism in hip fracture patients. Orthopedics, 2003, 26(8 Suppl): s851-s858.
16.	Eriksson BI, Bauer KA, Lassen MR, et al. Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after hip-fracture surgery. N Engl J Med, 2001, 345(18): 1298-1304.
17.	Sasaki S, Miyakoshi N, Matsuura H, et al. Prospective study on the efficacies of fondaparinux and enoxaparin in preventing venous thromboembolism after hip fracture surgery. J Orthop Sci, 2011, 16(1): 64-70.
18.	江玉, 曹燕, 王飛燕, 等. 血栓彈力圖與常規凝血指標對老年創傷性骨折患者術后下肢深靜脈血栓形成的預測價值分析. 中國醫學前沿雜志(電子版), 2021, 13(10): 112-116.
19.	俞豪, 費楊厚雪, 閔競, 等. RAPT 評分聯合血栓彈力圖 K 值及α角對創傷性骨折患者術后發生下肢深靜脈血栓的診斷價值. 檢驗醫學與臨床, 2024, 21(8): 1107-1110,1117.
20.	Brill JB, Badiee J, Zander AL, et al. The rate of deep vein thrombosis doubles in trauma patients with hypercoagulable thromboelastography. J Trauma Acute Care Surg, 2017, 83(3): 413-419.
21.	Gary JL, Schneider PS, Galpin M, et al. Can thrombelastography predict venous thromboembolic events in patients with severe extremity trauma?. J Orthop Trauma, 2016, 30(6): 294-298.
22.	Brown W, Lunati M, Maceroli M, et al. Ability of thromboelastography to detect hypercoagulability: a systematic review and meta-analysis. J Orthop Trauma, 2020, 34(6): 278-286.
23.	陳瀟, 李玲利, 何凌霄, 等. 血栓彈力圖參數聯合 D-二聚體、纖維蛋白原對老年髖部骨折患者深靜脈血栓形成的預測研究. 四川醫學, 2022, 43(11): 1091-1096.
24.	Kumar A, Talwar A, Farley JF, et al. Fondaparinux sodium compared with low-molecular-weight heparins for perioperative surgical thromboprophylaxis: a systematic review and meta-analysis. J Am Heart Assoc, 2019, 8(10): e012184.
25.	Cuker A, Arepally GM, Chong BH, et al. American society of hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv, 2018, 2(22): 3360-3392.
26.	Gu ZC, Wei AH, Zhang C, et al. Risk of major gastrointestinal bleeding with new vs conventional oral anticoagulants: a systematic review and meta-analysis. Clin Gastroenterol Hepatol, 2020, 18(4): 792-799. e61.
27.	Lundkvist J, Bergqvist D, J?nsson B. Cost-effectiveness of extended prophylaxis with fondaparinux compared with low molecular weight heparin against venous thromboembolism in patients undergoing hip fracture surgery. Eur J Health Econ, 2007, 8(4): 313-323.

1. Lyew MA, Isaacson IJ. Template for rapid analysis of the thromboelastogram. Anesth Analg, 1992, 74(5): 782-783.
2. Yang Y, Yao Z, Dai W, et al. Changes of thromboelastography in patients undergoing elective primary total knee and total hip replacement with low molecular heparin prophylaxis. J Orthop Surg Res, 2014, 9: 52.
3. Xu X, Jiang J, Liu W, et al. Application of thromboelastography to evaluate the effect of different routes administration of tranexamic acid on coagulation function in total hip arthroplasty. J Orthop Surg Res, 2019, 14(1): 430.
4. Gurunathan U, Stanton LM, Weir RM, et al. A preliminary study using rotational thromboelastometry to investigate perioperative coagulation changes and to identify hypercoagulability in obese patients undergoing total hip or knee replacement. Anaesth Intensive Care, 2019, 47(5): 461-468.
5. 呂波, 薛鋒, 唐果, 等. 下肢骨折后深靜脈血栓形成的影響因素分析. 國際骨科學雜志, 2018, 39(6): 373-377.
6. Lim TK, Koh KH, Lee SH, et al. Inferior anchor cortical perforation with arthroscopic bankart repair: a cadaveric study. Arthroscopy, 2013, 29(1): 31-36.
7. Fei C, Wang PF, Qu SW, et al. Deep vein thrombosis in patients with intertrochanteric fracture: a retrospective study. Indian J Orthop, 2020, 54(Suppl 1): 101-108.
8. Niu S, Li J, Zhao Y, et al. Preoperative deep venous thrombosis (DVT) after femoral neck fracture in the elderly, the incidence, timing, location and related risk factors. BMC Musculoskelet Disord, 2021, 22(1): 264.
9. 中華醫學會臨床藥學分會《磺達肝癸鈉藥學實踐專家共識》編寫工作組. 磺達肝癸鈉藥學實踐專家共識. 醫藥導報, 2022, 41(11): 1571-1581.
10. Sun G, Wu J, Wang Q, et al. Factor Ⅹa inhibitors and direct thrombin inhibitors versus low-molecular-weight heparin for thromboprophylaxis after total hip or total knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty, 2019, 34(4): 789-800. e6.
11. Bala A, Huddleston JI 3rd, Goodman SB, et al. Venous thromboembolism prophylaxis after tka: aspirin, warfarin, enoxaparin, or factor Ⅹa inhibitors?. Clin Orthop Relat Res, 2017, 475(9): 2205-2213.
12. Yang T, Liu Z, Zhang B, et al. Comparison of the efficacy of low-molecular-weight heparin and fondaparinux sodium after total knee arthroplasty: a retrospective cohort study. BMC Musculoskelet Disord, 2023, 24(1): 552.
13. 徐厚圍. 磺達肝癸鈉與低分子肝素在老年髖部骨折中預防深靜脈血栓的療效比較. 南充: 川北醫學院, 2023.
14. Kwong LM. Hip fracture and venous thromboembolism in the elderly. J Surg Orthop Adv, 2004, 13(3): 139-148.
15. Eriksson BI. Improvements in the prevention of postoperative venous thromboembolism in hip fracture patients. Orthopedics, 2003, 26(8 Suppl): s851-s858.
16. Eriksson BI, Bauer KA, Lassen MR, et al. Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after hip-fracture surgery. N Engl J Med, 2001, 345(18): 1298-1304.
17. Sasaki S, Miyakoshi N, Matsuura H, et al. Prospective study on the efficacies of fondaparinux and enoxaparin in preventing venous thromboembolism after hip fracture surgery. J Orthop Sci, 2011, 16(1): 64-70.
18. 江玉, 曹燕, 王飛燕, 等. 血栓彈力圖與常規凝血指標對老年創傷性骨折患者術后下肢深靜脈血栓形成的預測價值分析. 中國醫學前沿雜志(電子版), 2021, 13(10): 112-116.
19. 俞豪, 費楊厚雪, 閔競, 等. RAPT 評分聯合血栓彈力圖 K 值及α角對創傷性骨折患者術后發生下肢深靜脈血栓的診斷價值. 檢驗醫學與臨床, 2024, 21(8): 1107-1110,1117.
20. Brill JB, Badiee J, Zander AL, et al. The rate of deep vein thrombosis doubles in trauma patients with hypercoagulable thromboelastography. J Trauma Acute Care Surg, 2017, 83(3): 413-419.
21. Gary JL, Schneider PS, Galpin M, et al. Can thrombelastography predict venous thromboembolic events in patients with severe extremity trauma?. J Orthop Trauma, 2016, 30(6): 294-298.
22. Brown W, Lunati M, Maceroli M, et al. Ability of thromboelastography to detect hypercoagulability: a systematic review and meta-analysis. J Orthop Trauma, 2020, 34(6): 278-286.
23. 陳瀟, 李玲利, 何凌霄, 等. 血栓彈力圖參數聯合 D-二聚體、纖維蛋白原對老年髖部骨折患者深靜脈血栓形成的預測研究. 四川醫學, 2022, 43(11): 1091-1096.
24. Kumar A, Talwar A, Farley JF, et al. Fondaparinux sodium compared with low-molecular-weight heparins for perioperative surgical thromboprophylaxis: a systematic review and meta-analysis. J Am Heart Assoc, 2019, 8(10): e012184.
25. Cuker A, Arepally GM, Chong BH, et al. American society of hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv, 2018, 2(22): 3360-3392.
26. Gu ZC, Wei AH, Zhang C, et al. Risk of major gastrointestinal bleeding with new vs conventional oral anticoagulants: a systematic review and meta-analysis. Clin Gastroenterol Hepatol, 2020, 18(4): 792-799. e61.
27. Lundkvist J, Bergqvist D, J?nsson B. Cost-effectiveness of extended prophylaxis with fondaparinux compared with low molecular weight heparin against venous thromboembolism in patients undergoing hip fracture surgery. Eur J Health Econ, 2007, 8(4): 313-323.

West China Medical Journal

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