[Ortho] Антикоагулянты и раневые осложнения

[Gleb Korobushkin]

Коллеги!!
Несколько раз встречался с публикациями, что антикоакулянты повышают 
риск развития инфекционных раневых осложнений (SSI - surgical site 
infection). И вот еще читата из материалов AAOS 2016. Ривароксабан 
увеличивает в два раза... по сравнению с НМГ... при протезировании ТБС. 
Есть ли у кого свои собственные наблюдения?


Similarly, a multi-center study by Jameson et al comparing low molecular 
weight heparins for thromboprophylaxis was recently published. English 
hospital trusts replaced low molecular weight heparin with rivaroxaban 
for prophylaxis in lower-limb arthroplasty. There were significantly 
fewer wound complications in the low molecular weight heparin group 
(2.81% vs 3.85%; p=0.005). There was no difference in rates of pulmonary 
embolism, major bleeding or all-cause mortality. Jensen et al also noted 
a greater number of wound complications (1.8% vs 3.94%; p=0.046) in 
patients receiving rivaroxaban compared to tinzaparin. The morbidity of 
repeat surgeries associated with rivaroxaban without a reported benefit 
of fewer pulmonary emboli events is of great concern. The concern is 
especially relevant as the control or comparison group treatment (low 
molecular weight heparin) has also been associated with increased wound 
drainage and infection when compared to other means of thromboembolic 
disease prevention

Gleb Korobushkin


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