Efficacy and safety of Fondaparinux against enoxaparin among patients undergoing orthopaedic surgery in Hospital Selayang / Siti Syarihan Abdullah

Venous thromboembolism (VTE) is a common complication in orthopaedic surgery patients. Malaysian Clinical Practice Guidelines (CPG) on Prevention and Treatment of Venous Thromboembolism (2013) has recommended both enoxaparin and fondaparinux as the VTE prophylaxis. Although many studies had been con...

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Main Author:	Abdullah, Siti Syarihan
Format:	Thesis
Language:	English
Published:	2017
Subjects:	General special Patient monitoring Special situations and conditions
Online Access:	https://ir.uitm.edu.my/id/eprint/26265/1/TM_SITI%20SYARIHAN%20ABDULLAH%20PH%2017_5.pdf
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spelling	my-uitm-ir.262652019-10-23T08:30:59Z Efficacy and safety of Fondaparinux against enoxaparin among patients undergoing orthopaedic surgery in Hospital Selayang / Siti Syarihan Abdullah 2017 Abdullah, Siti Syarihan General special. Patient monitoring Medical emergencies. Critical care. Intensive care. First aid Special situations and conditions Venous thromboembolism (VTE) is a common complication in orthopaedic surgery patients. Malaysian Clinical Practice Guidelines (CPG) on Prevention and Treatment of Venous Thromboembolism (2013) has recommended both enoxaparin and fondaparinux as the VTE prophylaxis. Although many studies had been conducted to evaluate the safety and efficacy of fondaparinux as VTE prophylaxis, there is no study ever conducted in Malaysia to determine the efficacy and safety of fondaparinux against enoxaparin among orthopaedic patients. Furthermore, the genetic diversity between patients in Malaysia and in overseas may limit the generalizability of the previous study’s findings. The objective of this study was to evaluate the efficacy and safety of fondaparinux against enoxaparin as VTE prevention among patients undergoing orthopaedic surgery in Hospital Selayang. This study was conducted retrospectively by examining electronic medical records of all patients receiving either fondaparinux or enoxaparin as a VTE prophylaxis for orthopaedic surgery in Hospital Selayang from 1st January until 31st December 2015. A total of 99 patients in enoxaparin group and 38 patients in fondaparinux group were included in the study. There were 3 cases of VTE observed in enoxaparin group, while no VTE incidence was observed in fondaparinux group. The number of major bleeding events detected was 42 cases (42.4%) in enoxaparin group and 13 cases (34.2%) in fondaparinux group. No association was found between these two groups for VTE and major bleeding incidences (p = 0.56 and 0.38 respectively). Variable associated with VTE incidence was obesity (p=0.02). While independent predictor for major bleeding incidence was the timing start of propylaxis (p=0.01). When adjusted for confounders like timing start of prophylaxis and concomitant antiplatelet, the number of concurrent medication also had a significant relationship with major bleeding (p=0.037). In conclusion, fondaparinux had similar efficacy and safety profiles with enoxaparin in preventing VTE in orthopaedic surgery patients. VTE incidence following orthopaedic surgery was associated with obesity, while major bleeding incidence was influenced by the timing start of VTE prophylaxis. The number of concurrent medication was also a significant contributor to major bleeding, when adjusted for other confounders. Keywords: fondaparinux, enoxaparin, VTE, major bleeding, orthopaedic surgery 2017 Thesis https://ir.uitm.edu.my/id/eprint/26265/ https://ir.uitm.edu.my/id/eprint/26265/1/TM_SITI%20SYARIHAN%20ABDULLAH%20PH%2017_5.pdf text en public masters Universiti Teknologi MARA Faculty of Pharmacy
institution	Universiti Teknologi MARA
collection	UiTM Institutional Repository
language	English
topic	General special Patient monitoring General special Patient monitoring Special situations and conditions
spellingShingle	General special Patient monitoring General special Patient monitoring Special situations and conditions Abdullah, Siti Syarihan Efficacy and safety of Fondaparinux against enoxaparin among patients undergoing orthopaedic surgery in Hospital Selayang / Siti Syarihan Abdullah
description	Venous thromboembolism (VTE) is a common complication in orthopaedic surgery patients. Malaysian Clinical Practice Guidelines (CPG) on Prevention and Treatment of Venous Thromboembolism (2013) has recommended both enoxaparin and fondaparinux as the VTE prophylaxis. Although many studies had been conducted to evaluate the safety and efficacy of fondaparinux as VTE prophylaxis, there is no study ever conducted in Malaysia to determine the efficacy and safety of fondaparinux against enoxaparin among orthopaedic patients. Furthermore, the genetic diversity between patients in Malaysia and in overseas may limit the generalizability of the previous study’s findings. The objective of this study was to evaluate the efficacy and safety of fondaparinux against enoxaparin as VTE prevention among patients undergoing orthopaedic surgery in Hospital Selayang. This study was conducted retrospectively by examining electronic medical records of all patients receiving either fondaparinux or enoxaparin as a VTE prophylaxis for orthopaedic surgery in Hospital Selayang from 1st January until 31st December 2015. A total of 99 patients in enoxaparin group and 38 patients in fondaparinux group were included in the study. There were 3 cases of VTE observed in enoxaparin group, while no VTE incidence was observed in fondaparinux group. The number of major bleeding events detected was 42 cases (42.4%) in enoxaparin group and 13 cases (34.2%) in fondaparinux group. No association was found between these two groups for VTE and major bleeding incidences (p = 0.56 and 0.38 respectively). Variable associated with VTE incidence was obesity (p=0.02). While independent predictor for major bleeding incidence was the timing start of propylaxis (p=0.01). When adjusted for confounders like timing start of prophylaxis and concomitant antiplatelet, the number of concurrent medication also had a significant relationship with major bleeding (p=0.037). In conclusion, fondaparinux had similar efficacy and safety profiles with enoxaparin in preventing VTE in orthopaedic surgery patients. VTE incidence following orthopaedic surgery was associated with obesity, while major bleeding incidence was influenced by the timing start of VTE prophylaxis. The number of concurrent medication was also a significant contributor to major bleeding, when adjusted for other confounders. Keywords: fondaparinux, enoxaparin, VTE, major bleeding, orthopaedic surgery
format	Thesis
qualification_level	Master's degree
author	Abdullah, Siti Syarihan
author_facet	Abdullah, Siti Syarihan
author_sort	Abdullah, Siti Syarihan
title	Efficacy and safety of Fondaparinux against enoxaparin among patients undergoing orthopaedic surgery in Hospital Selayang / Siti Syarihan Abdullah
title_short	Efficacy and safety of Fondaparinux against enoxaparin among patients undergoing orthopaedic surgery in Hospital Selayang / Siti Syarihan Abdullah
title_full	Efficacy and safety of Fondaparinux against enoxaparin among patients undergoing orthopaedic surgery in Hospital Selayang / Siti Syarihan Abdullah
title_fullStr	Efficacy and safety of Fondaparinux against enoxaparin among patients undergoing orthopaedic surgery in Hospital Selayang / Siti Syarihan Abdullah
title_full_unstemmed	Efficacy and safety of Fondaparinux against enoxaparin among patients undergoing orthopaedic surgery in Hospital Selayang / Siti Syarihan Abdullah
title_sort	efficacy and safety of fondaparinux against enoxaparin among patients undergoing orthopaedic surgery in hospital selayang / siti syarihan abdullah
granting_institution	Universiti Teknologi MARA
granting_department	Faculty of Pharmacy
publishDate	2017
url	https://ir.uitm.edu.my/id/eprint/26265/1/TM_SITI%20SYARIHAN%20ABDULLAH%20PH%2017_5.pdf
_version_	1783733889929314304

Efficacy and safety of Fondaparinux against enoxaparin among patients undergoing orthopaedic surgery in Hospital Selayang / Siti Syarihan Abdullah

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