Early Postoperative Bleeding in Polytrauma Patients Treated with Fondaparinux: Literature Review and Institutional Experience

Eleftherios      Tsiridis; Zakareya      Gamie; Marc      J. George; Daisy      Hamilton-Baille; Robert      M. West; Peter      V. Giannoudis

Abstract

Surgery for pelvic or acetabular fractures carries a high risk of deep-vein thrombosis (DVT). Reports indicate that fondaparinux is a more effective thromboprophylactic agent than low molecular weight heparin (LMWH) after major orthopaedic surgery. The safety and efficacy of fondaparinux was evaluated in a new protocol used for DVT prophylaxis. One hundred and twenty seven patients with pelvic or acetabular fractures received either fondaparinux or enoxaparin and were analysed in a historical non-concurrent study. Specific review points included clinical deep-vein thrombosis (DVT) or pulmonary embolism (PE) and evidence of adverse effects such as bleeding or allergic reactions. Two patients that received enoxaparin were found to have a DVT and one patient had a PE. There was no documented DVT or PE in patients that received fondaparinux. The mean number of units of blood transfused postoperatively was higher in the enoxaparin group; however, multivariate regression modelling demonstrated no significant difference between the groups. The most current large randomised controlled studies investigating the administration of fondaparinux following joint arthroplasty or hip fracture surgery, have demonstrated a slight increase or a similar number of bleeding events in patients treated with fondaparinux when compared to those treated with enoxaparin. The current report supports that fondaparinux, in patients with pelvic and acetabular fractures, can be equally effective as enoxaparin and not associated with adverse bleeding events.

Keywords: Pelvis, acetabulum, fracture, deep-vein thrombosis, anticoagulant, enoxaparin, fondaparinux, thromboprophylactic agent, LMWH, pulmonary embolism, pentasaccharide, postoperative thromboprophylaxis, CF, Severity Score (ISS), heparin, pentasaccharides, acute bacterial endocarditis, severe renal impairment, current ulceration, haemorrhagic stroke, ophthal-mological surgery, CT-pulmonary angiography, deranged clotting, bin time, prothrombin time, activated partial, STATA, ISS, FDA, p value, pruritis, PENTIFRA, EPHESUS, PENTAMAKS, PENTHIFRA, meta-analysis, double-blind trials, prophylaxis, placebo, fatal bleeding, critical organ bleeding, demographics, venography, polytrauma patients