Comparison of Hematologic Changes between Rivaroxaban and Aspirin for Venous Thromboembolism Prophylaxis after Total Knee Arthroplasty

Moo-Ho Song; Bu-Hwan Kim; Seong-Jun Ahn; Seong-Ho Yoo; Yeong-Joon Kim

doi:10.4055/jkoa.2012.47.6.410

Journal List > J Korean Orthop Assoc > v.47(6) > 1013187

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Song, Kim, Ahn, Yoo, and Kim: Comparison of Hematologic Changes between Rivaroxaban and Aspirin for Venous Thromboembolism Prophylaxis after Total Knee Arthroplasty

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(6): 410-415.

Published online: 28 December 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.6.410

Comparison of Hematologic Changes between Rivaroxaban and Aspirin for Venous Thromboembolism Prophylaxis after Total Knee Arthroplasty

Moo-Ho Song, M.D., Bu-Hwan Kim, M.D., Seong-Jun Ahn, M.D., Seong-Ho Yoo, M.D., Yeong-Joon Kim, M.D.

Department of Orthopaedic Surgery, Daedong General Hospital, Busan, Korea.

Correspondence to: Seong-Ho Yoo, M.D. Department of Orthopaedic Surgery, Daedong General Hospital, 187, Chungnyeol-daero, Dongnae-gu, Busan 607-711, Korea. TEL: +82-51-554-8996, FAX: +82-51-553-7575, mhsong21@hanmail.net

Received 12 February 2012 Revised 25 April 2012 Accepted 21 June 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the hematologic changes and the rates of transfusion of patients using rivaroxaban or aspirin for venous thromboembolism prophylaxis after a total knee arthroplasty.

Materials and Methods

Among patients with total knee arthroplasty from July 2010 to March 2011, two groups of 100 consecutive cases were enrolled in this study, 50 patients with Rivaroxaban group and 50 patients with Aspirin group for venous thromboembolism prophylaxis after a total knee arthoplasty. Hematologic changes and transfusion rates were calculated in each group.

Results

The mean of decreased hemoglobin was 4.7 (3.1-6.6) in the Rivaroxaban group and 3.6 (2.0-5.1) in the Aspirin group (p<0.05). The number of patients with decreased hemoglobin of less than 8 g/dl was observed in 23 cases (46%) in the Rivaroxaban group, and 9 cases (18%) in the Aspirin group. The numbers of patients who needed transfusion were 12 in the Rivaroxaban group, and 2 in the Aspirin group (p<0.05).

Conclusion

Rivaroxaban group revealed more significant decrease of hemoglobin and needed more transfusion than the Aspirin group did. For the prevention of venous thromboembolism after total knee arthroplasty, we should be careful using Rivaroxaban for the standard risk patients of venous thromboembolism.

Keywords: arthroplasty, knee, venous thromboembolism, Rivaroxaban, Aspirin

Figures and Tables

Table 1

Demographics, Hematologic Data and Transfusion Rates

^*1 unit of packed red cell: 320 ml; ^†T-test; ^‡Chi-square test. BMI, body mass index; SD, standard deviation; BT, bleeding time; CT, clotting time; PT, prothrombin time; aPTT, activated partial thromboplastin time.

References

1. Bjørnarå BT, Gudmundsen TE, Dahl OE. Frequency and timing of clinical venous thromboembolism after major joint surgery. J Bone Joint Surg Br. 2006. 88:386–391.

2. Kim YH, Kim JS. Incidence and natural history of deep-vein thrombosis after total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br. 2002. 84:566–570.

3. Song EK, Seon JK, Park SJ, Cho SB, Choi MS. Diagnosis of the deep vein thrombosis with multidetector-row computed tomographic venography after total knee arthroplasty. J Korean Orthop Assoc. 2008. 43:294–300.

4. Ko PS, Chan WF, Siu TH, Khoo J, Wu WC, Lam JJ. Deep venous thrombosis after total hip or knee arthroplasty in a "low-risk" Chinese population. J Arthroplasty. 2003. 18:174–179.

5. American Academy of Orthopaedic Surgeons (AAOS). American academy of orthopaedic surgeons clinical guideline on prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty page[Internet]. 2011. cited 2012 Feb 12. Rosemont(IL): AAOS;Available from: http://www.aaos.org/research/guidelines/VTE/VTE_guideline.asp.

6. Borris LC. Rivaroxaban and dabigatran etexilate: two new oral anticoagulants for extended postoperative prevention of venous thromboembolism after elective total hip arthroplasty. Arch Orthop Trauma Surg. 2010. 130:583–589.

7. Duggan ST, Scott LJ, Plosker GL. Rivaroxaban: a review of its use for the prevention of venous thromboembolism after total hip or knee replacement surgery. Drugs. 2009. 69:1829–1851.

8. Dahl OE, Quinlan DJ, Bergqvist D, Eikelboom JW. A critical appraisal of bleeding events reported in venous thromboembolism prevention trials of patients undergoing hip and knee arthroplasty. J Thromb Haemost. 2010. 8:1966–1975.

9. Eriksson BI, Borris LC, Dahl OE, et al. A once-daily, oral, direct Factor Xa inhibitor, rivaroxaban (BAY 59-7939), for thromboprophylaxis after total hip replacement. Circulation. 2006. 114:2374–2381.

10. British Committee, Stainsby D, MacLennan S, Thomas D, Isaac J, Hamilton PJ. Guidelines on the management of massive blood loss. Br J Haematol. 2006. 135:634–641.

11. Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008. 133:381S–453S.

12. Eikelboom JW, Karthikeyan G, Fagel N, Hirsh J. American Association of Orthopedic Surgeons and American College of Chest Physicians guidelines for venous thromboembolism prevention in hip and knee arthroplasty differ: what are the implications for clinicians and patients? Chest. 2009. 135:513–520.

13. Hill J, Treasure T;. Reducing the risk of venous thromboembolism in patients admitted to hospital: summary of NICE guidance. BMJ. 2010. 340:c95.

14. Turpie AG, Lassen MR, Davidson BL, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet. 2009. 373:1673–1680.

15. Warwick DJ, Whitehouse S. Symptomatic venous thromboembolism after total knee replacement. J Bone Joint Surg Br. 1997. 79:780–786.

16. Patterson BM, Marchand R, Ranawat C. Complications of heparin therapy after total joint arthroplasty. J Bone Joint Surg Am. 1989. 71:1130–1134.

17. Kim YH, Yoo JH, Kim JS. Factors leading to decreased rates of deep vein thrombosis and pulmonary embolism after total knee arthroplasty. J Arthroplasty. 2007. 22:974–980.

18. Klatsky AL, Armstrong MA, Poggi J. Risk of pulmonary embolism and/or deep venous thrombosis in Asian-Americans. Am J Cardiol. 2000. 85:1334–1337.

19. Khaw FM, Moran CG, Pinder IM, Smith SR. The incidence of fatal pulmonary embolism after knee replacement with no prophylactic anticoagulation. J Bone Joint Surg Br. 1993. 75:940–941.

20. Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston textbook of surgery. 2008. 18th ed. Philadelphia: Saunders;130–135.

TOOLS

Similar articles