Document Detail

Oral direct thrombin inhibitor ximelagatran compared with warfarin for the prevention of venous thromboembolism after total knee arthroplasty.
MedLine Citation:
PMID:  16203879     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Warfarin, which requires coagulation monitoring, is associated with relatively high rates of thromboembolism despite providing adequate prophylaxis. This study compared an oral direct thrombin inhibitor, ximelagatran, with warfarin in order to evaluate the safety and efficacy of the medication for the prevention of venous thromboembolism in patients undergoing total knee arthroplasty. METHODS: Following surgery, patients were randomly assigned to fixed-dose oral ximelagatran (36 mg twice daily) or warfarin (target international normalized ratio, 2.5), both administered for seven to twelve days in a double-blind, double-dummy design. Warfarin was initiated on the evening of the day of surgery, and ximelagatran, on the morning after surgery. The primary efficacy end point was the incidence of asymptomatic deep-vein thrombosis determined by bilateral venography, objectively confirmed symptomatic deep-vein thrombosis or pulmonary embolism, and death from all causes during treatment. RESULTS: Adequate venograms or confirmed symptomatic events (efficacy population) were obtained for 1949 patients. Venous thromboembolism and death from all causes occurred in 22.5% (221) of 982 ximelagatran-treated patients and in 31.9% (308) of 967 warfarin-treated patients (p < 0.001). Proximal deep-vein thrombosis and pulmonary embolism were observed in 3.1% (thirty) and 0.2%, respectively, of the patients in the ximelagatran group and in 3.4% (thirty-three) and 0.4%, respectively, of the patients in the warfarin group. The six deaths from all causes included 0.3% (four) of the ximelagatran-treated patients and 0.2% (two) of the warfarin-treated patients. Major bleeding was noted in 1% (twelve) of the ximelagatran-treated patients and in 0.4% (five) of the warfarin-treated patients (p = 0.09). CONCLUSIONS: Oral ximelagatran (36 mg twice daily), administered without coagulation monitoring or dose adjustment and started the day after total knee arthroplasty, demonstrates superior efficacy compared with warfarin prophylaxis, with no wound complications and no significant difference with respect to bleeding events, although the rate of major bleeding events was greater with ximelagatran than with warfarin. LEVEL OF EVIDENCE: Therapeutic Level I.
Clifford W Colwell; Scott D Berkowitz; Jay R Lieberman; Philip C Comp; Jeffrey S Ginsberg; Guy Paiement; Jennifer McElhattan; Anne W Roth; Charles W Francis;
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of bone and joint surgery. American volume     Volume:  87     ISSN:  0021-9355     ISO Abbreviation:  J Bone Joint Surg Am     Publication Date:  2005 Oct 
Date Detail:
Created Date:  2005-10-05     Completed Date:  2005-11-08     Revised Date:  2010-10-25    
Medline Journal Info:
Nlm Unique ID:  0014030     Medline TA:  J Bone Joint Surg Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2169-77     Citation Subset:  AIM; IM    
Orthopaedic Surgery, Scripps Clinic, 11025 North Torrey Pines Road, Suite 140, La Jolla, CA 92037, USA.
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MeSH Terms
Anticoagulants / therapeutic use*
Arthroplasty, Replacement, Knee / adverse effects*
Azetidines / therapeutic use*
Double-Blind Method
Middle Aged
Prospective Studies
Pulmonary Embolism / etiology,  prevention & control
Treatment Outcome
Venous Thrombosis / etiology,  prevention & control*
Warfarin / therapeutic use*
Reg. No./Substance:
0/Anticoagulants; 0/Azetidines; 0/Benzylamines; 0/ximelagatran; 81-81-2/Warfarin
Comment In:
J Bone Joint Surg Am. 2006 May;88(5):1163; author reply 1163-5   [PMID:  16651602 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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