Comparative Effectiveness and Safety of Drug Prophylaxis for Prevention of Venous Thromboembolism After Total Knee Arthroplasty.

BACKGROUND: Rates of venous thromboembolism in contemporary studies of primary total knee arthroplasty (TKA) have been reported to be as high as 3.5%. Although drug prophylaxis is effective, the best option among these regimens is not well established. The purpose of this study was to evaluate the comparative effectiveness and safety of aspirin, low-molecular-weight heparin, synthetic pentasaccharide factor Xa inhibitors, and vitamin K antagonist. METHODS: Data were from a US total joint replacement registry, with 30,499 patients receiving unilateral TKA from May 16, 2006, to December 31, 2013. Patients received either aspirin (324-325 mg daily), enoxaparin (40-60 mg daily), fondaparinux (2.5 mg daily), or warfarin (all doses) and were followed up 90 days postoperatively on several outcomes: deep vein thrombosis, pulmonary embolism, major bleeding, wound complications, infection, and death. RESULTS: There was no evidence that fondaparinux, enoxaparin, or warfarin were superior to aspirin in the prevention of pulmonary embolism, deep vein thrombosis, or venous thromboembolism or that aspirin was safer than these alternatives. However, enoxaparin was found to be as safe as aspirin with respect to bleeding, and fondaparinux was as safe as aspirin for risk of wound complications. CONCLUSION: Among TKA patients, we did not find evidence for decreased effectiveness or increased safety with use of aspirin, but enoxaparin had comparable safety to aspirin for bleeding and fondaparinux had comparable safety to aspirin for wound complications.

The prevalence and trends of antiviral medication use during pregnancy in the US: a population-based study of 664,297 deliveries in 2001-2007.

To evaluate the prevalence, trends, timing and duration of exposure to antiviral medications during pregnancy within a US cohort of pregnant women and to evaluate the proportion of deliveries with a viral infection diagnosis among women given antiviral medication during pregnancy. Live-born deliveries between 2001 and 2007, to women aged 15-45 years, were included from the Medication Exposure in Pregnancy Risk Evaluation Program, a collaborative research program between the U.S. Food and Drug Administration and eleven health plans. They were evaluated for prevalence, timing, duration, and temporal trends of exposure to antiviral medications during pregnancy. We also calculated the proportion of deliveries with a viral infection diagnosis among those exposed to antiviral medications. Among 664,297 live births, the overall prevalence of antiviral exposure during pregnancy was 4 % (n = 25,155). Between 2001 and 2007, antiviral medication exposure during pregnancy doubled from 2.5 to 5 %. The most commonly used antiviral medication was acyclovir, with 3 % of the deliveries being exposed and most of the exposure occurring after the 1st trimester. Most deliveries exposed to antiviral medications were exposed for less than 30 days (2 % of all live births). Forty percent of the women delivering an infant exposed to antiviral medications had a herpes diagnosis. Our findings highlight the increased prevalence of women delivering an infant exposed to antiviral medications over time. These findings support the need for large, well-designed studies to assess the safety and effectiveness of these medications during pregnancy.

Impact of MMRV combination vaccine on childhood vaccination compliance.

OBJECTIVE: To assess the impact of using the combined measles, mumps, rubella, and varicella vaccine (MMRV) instead of the measles, mumps, and rubella vaccine and the varicella vaccine separately (MMR+V) on uptake of vaccines recommended by the Advisory Committee for Immunization Practices (ACIP) in young children. STUDY DESIGN: Retrospective cohort study. METHODS: Electronic immunization records of children 12 to 15 months of age who received either MMR+V (n = 29,716) or MMRV (n = 29,711) between November 2003 and June 2007 while enrolled in Kaiser Permanente Southern California were evaluated. Proportions of children who received either MMRV or MMR+V and other ACIP-recommended vaccines either simultaneously or during recommended age intervals were compared. RESULTS: Concomitant administration of DTaP (76.3 vs 75.6%), PCV7 (89.1 vs 78.6%), Hib (92.3 vs 91.3%), and hepatitis A vaccine (HAV) (44.2 vs 0.1%) and on-time administration of PCV7 (91.7 vs 78.7%), Hib (93.9 vs 93.2%), and HAV (86.8 vs 24.3%) were greater with MMRV than with MMR+V. On-time administration of DTaP (91.4 vs 90.5%) and IPV (91.3 vs 90.0%) was greater with MMR+V than with MMRV. CONCLUSIONS: Concomitant and on-time administration of most ACIP-recommended vaccines was greater with MMRV than with MMR+V despite the addition of HAV to the recommended schedule after introduction of MMRV. However, the modest compliance increases suggest that focusing on other barriers to compliance may be important to increasing adherence to future vaccination recommendations.