IMPACT OF IVAROXABAN ON HIDDEN BLOOD LOSS AND BLOOD TRANSFUSION RATE AFTER PRIMARY TOTAL KNEE ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Guodong , ZHANG Yuanmin , ZHAO Xiaowei , ZHANG Yuge , WANG Lei , KONG Ying. Department of Bone and Joint

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Keywords：

Total knee arthroplasty Ivaroxaban; Low molecular weight heparin; Bleeding; Hidden blood loss

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Objective To analyze the impact of ivaroxaban on hidden blood loss and blood transfusion rate after primary total knee arthroplasty (TKA) by comparing with the use of low molecular weight heparin. Methods Between December 2009 and January 2011, the clinical data from 90 patients undergoing primary TKA were retrospectively analyzed. At 12 hours after operation, 45 patients were given ivaroxaban (10 mg/d) in the trial group and low molecular weight heparin injection (0.4 mL/d) in the control group for 14 days, respectively. There was no significant difference in gender, age, disease duration, or range of motion between 2 groups (P gt; 0.05). Results The operation time was (92.32 ± 23.13) minutes in the trial group and (89.81 ± 18.65) minutes in the control group, showing no significant difference (t=0.26, P=0.79). The hidden blood loss was (40.18 ± 14.85) g/L in the trial group and (34.04 ± 12.96) g/L in the control group, showing significant difference (t=2.09, P=0.00); the dominant blood loss was (30.60 ± 2.89) g/L and (28.85 ± 8.10) g/L respectively, showing no significant difference (t= 1.37, P=0.17). The blood transfusion rate was 73.33% (33/45) in the trial group and 55.56% (25/45) in the control group, showing no sigificant difference (χ2=3.10, P=0.08); the transfusion volume was (1.44 ± 1.09) U and (1.06 ± 1.17) U respectively, showing no significant difference (t=1.58, P=0.11). Stress ulcer occurred in 1 case of the trial group; symptomatic deep vein thrombosis of lower extremity and asymptomatic muscular venous thrombosis developed in 1 case and 4 cases of the control group respectively. Conclusion Ivaroxaban has effect on the hidden blood loss after primary TKA, which may increase postoperative blood loss and blood transfusion rate. The changes in hemoglobin should be monitored during the anticoagulant therapy, and the blood volume should be added promptly.

Citation： WANG Guodong,ZHANG Yuanmin,ZHAO Xiaowei,ZHANG Yuge,WANG Lei,KONG Ying. Department of Bone and Joint,Affiliated Hospital of Jining Medical College,Jining Shandong,P.R.China. Corresponding author WANG Guodong,Email wangguodongya.com. IMPACT OF IVAROXABAN ON HIDDEN BLOOD LOSS AND BLOOD TRANSFUSION RATE AFTER PRIMARY TOTAL KNEE ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(11): 1306-1309. doi: Copy

1.	Bozic KJ, Vail TP, Pekow PS, et al. Does aspirin have a role in venous thromboembolism prophylaxis in total knee arthroplasty patients? J Arthroplasty, 2010, 25(7): 1053-1060.
2.	Lotke PA, Lonner JH. The benefit of aspirin chemoprophylaxis for thromboembolism after total knee arthroplasty. Clin Orthop Relat Res, 2006, (452): 175-180.
3.	Bell TH, Berta D, Ralley F, et al. Factors affecting perioperative blood loss and transfusion rates in primary total joint arthroplasty: a prospective analysis of 1 642 patients. Can J Surg, 2009, 52(4): 295-301.
4.	Schnurr C, Csécsei G, Eysel P, et al. The effect of computer navigation on blood loss and transfusion rate in TKA. Orthopedics, 2010, 33(7): 474.
5.	Muñoz M, García-Vallejo JJ, Ruiz MD, et al. Transfusion of post-operative shed blood: laboratory characteristics and clinical utility. Eur Spine J, 2004, 13 Suppl 1: S107-S113.
6.	Alban S. From heparins to factor Xa inhibitors and beyond. Eur J Clin Invest, 2005, 35 Suppl 1: 12-20.
7.	Ryttberg L, Diamantopoulos A, Forster F, et al. Cost-effectiveness of rivaroxaban versus heparins for prevention of venous thromboembolism after total hip or knee surgery in Sweden. Expert Rev Pharmacoecon Outcomes Res, 2011, 11(5): 601-615.
8.	Alves C, Batel-Marques F, Macedo AF. Apixaban and rivaroxaban safety after hip and knee arthroplasty: a meta-analysis. J Cardiovasc Pharmacol Ther, 2012, 17(3): 266-276.
9.	Fassiadis N. Rivaroxaban: direct factor Xa inhibition to treat acute deep vein thrombosis. Br J Hosp Med (Lond), 2011, 72(9): 486.
10.	Eriksson BI, Borris LC, Friedman RJ, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med, 2008, 358(26): 2765-2775.
11.	Kakkar AK, Brenner B, Dahl OE, et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet, 2008, 372(9632): 31-39.
12.	Lassen MR, Ageno W, Borris LC, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med, 2008, 358(26): 2776-2786.
13.	Turpie AG, Lassen MR, Davidson BL, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet, 2009, 373(9676): 1673-1680.
14.	Deeks ED. Apixaban: a review of its use in the prevention of venous thromboembolism after knee or hip replacement surgery. Drugs, 2012, 72(9): 1271-1291.
15.	Witt DM. Rivaroxaban and usual care had similar rates of recurrent VTE and bleeding in symptomatic PE. Ann Intern Med, 2012, 157(4): JC2-6.
16.	Beyer-Westendorf J, Lützner J, Donath L, et al. Efficacy and safety of rivaroxaban or fondaparinux thromboprophylaxis in major orthopaedic surgery-findings from the ortho-tep registry. J Thromb Haemost, 2012, 10(10): 2045-2052.
17.	Eriksson BI, Borris LC, Dahl OE, et al. Oral, direct factor Xa inhibition with BAY 59-7939 for the prevention of venous thromboembolism after total hip replacement. J Thromb Haemost, 2006, 4(1): 121-128.
18.	Horloeker TT. Low molecular weight heparin and neuraxial anesthesia. Thromb Res, 2001, 101(1): V141-154.
19.	马卫华, 张树栋, 慕宏杰, 等. 低分子肝素使用时机对关节置换手术失血量和DVT发生率的影响. 中华骨科杂志, 2008, 28(10): 833-837.

1. Bozic KJ, Vail TP, Pekow PS, et al. Does aspirin have a role in venous thromboembolism prophylaxis in total knee arthroplasty patients? J Arthroplasty, 2010, 25(7): 1053-1060.
2. Lotke PA, Lonner JH. The benefit of aspirin chemoprophylaxis for thromboembolism after total knee arthroplasty. Clin Orthop Relat Res, 2006, (452): 175-180.
3. Bell TH, Berta D, Ralley F, et al. Factors affecting perioperative blood loss and transfusion rates in primary total joint arthroplasty: a prospective analysis of 1 642 patients. Can J Surg, 2009, 52(4): 295-301.
4. Schnurr C, Csécsei G, Eysel P, et al. The effect of computer navigation on blood loss and transfusion rate in TKA. Orthopedics, 2010, 33(7): 474.
5. Muñoz M, García-Vallejo JJ, Ruiz MD, et al. Transfusion of post-operative shed blood: laboratory characteristics and clinical utility. Eur Spine J, 2004, 13 Suppl 1: S107-S113.
6. Alban S. From heparins to factor Xa inhibitors and beyond. Eur J Clin Invest, 2005, 35 Suppl 1: 12-20.
7. Ryttberg L, Diamantopoulos A, Forster F, et al. Cost-effectiveness of rivaroxaban versus heparins for prevention of venous thromboembolism after total hip or knee surgery in Sweden. Expert Rev Pharmacoecon Outcomes Res, 2011, 11(5): 601-615.
8. Alves C, Batel-Marques F, Macedo AF. Apixaban and rivaroxaban safety after hip and knee arthroplasty: a meta-analysis. J Cardiovasc Pharmacol Ther, 2012, 17(3): 266-276.
9. Fassiadis N. Rivaroxaban: direct factor Xa inhibition to treat acute deep vein thrombosis. Br J Hosp Med (Lond), 2011, 72(9): 486.
10. Eriksson BI, Borris LC, Friedman RJ, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med, 2008, 358(26): 2765-2775.
11. Kakkar AK, Brenner B, Dahl OE, et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet, 2008, 372(9632): 31-39.
12. Lassen MR, Ageno W, Borris LC, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med, 2008, 358(26): 2776-2786.
13. Turpie AG, Lassen MR, Davidson BL, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet, 2009, 373(9676): 1673-1680.
14. Deeks ED. Apixaban: a review of its use in the prevention of venous thromboembolism after knee or hip replacement surgery. Drugs, 2012, 72(9): 1271-1291.
15. Witt DM. Rivaroxaban and usual care had similar rates of recurrent VTE and bleeding in symptomatic PE. Ann Intern Med, 2012, 157(4): JC2-6.
16. Beyer-Westendorf J, Lützner J, Donath L, et al. Efficacy and safety of rivaroxaban or fondaparinux thromboprophylaxis in major orthopaedic surgery-findings from the ortho-tep registry. J Thromb Haemost, 2012, 10(10): 2045-2052.
17. Eriksson BI, Borris LC, Dahl OE, et al. Oral, direct factor Xa inhibition with BAY 59-7939 for the prevention of venous thromboembolism after total hip replacement. J Thromb Haemost, 2006, 4(1): 121-128.
18. Horloeker TT. Low molecular weight heparin and neuraxial anesthesia. Thromb Res, 2001, 101(1): V141-154.
19. 马卫华, 张树栋, 慕宏杰, 等. 低分子肝素使用时机对关节置换手术失血量和DVT发生率的影响. 中华骨科杂志, 2008, 28(10): 833-837.

Chinese Journal of Reparative and Reconstructive Surgery

IMPACT OF IVAROXABAN ON HIDDEN BLOOD LOSS AND BLOOD TRANSFUSION RATE AFTER PRIMARY TOTAL KNEE ARTHROPLASTY

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