rivaroxaban and Blood-Loss--Surgical

Tranexamic acid (TXA) combined with rivaroxaban (RA) has been widely used in total knee replacement (TKA). This meta-analysis explored the clinical effects of TXA combined with RA on reducing bleeding and preventing venous thrombosis in patients with unilateral TKA.. Five controlled clinical studies that met the inclusion criteria were collected from PubMed, Embase and Cochrane libraries. Fixed effect model and random effect model were used to compare the TXA + RA group with the RA group in 731 patients.. Decrease of hemoglobin (Hb), total blood loss, transfusion rate and wound complications of the TXA + RA group is lower than the RA group, the difference was statistically significant (. The application of TXA combined with RA in the TKA can effectively reduce blood loss without increasing the risk of DVT. However, it should be noted that TXA combined with RA after TKA has a potential increased risk of wound complications.

Topics: Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Humans; Randomized Controlled Trials as Topic; Rivaroxaban; Tranexamic Acid

Total knee arthroplasty is an elective procedure performed on relatively healthy individuals. However, due to the inherent risk of venous thromboembolism, drugs are used for its prophylaxis. The objective of the present study was to conduct a systematic review of the literature to compare the efficacy of enoxaparin and rivaroxaban in preventing this complication and the risk of intraoperative bleeding. We reviewed the SciELO, Pubmed and Cochrane databases with the descriptors knee arthroplasty, rivaroxaban and enoxaparin through the PICO search strategy. Inclusion criteria were the articles during the study period comparing both drugs in knee arthroplasty. Relevant criteria to study eligibility were articles published since 2010 and with a sample of more than 20 patients; studies obtained in their entirety; and studies with follow-up of more than 12 months. The variables used to compare the articles were the most common postoperative complications of knee arthroplasties: venous thromboembolism and bleeding. We used the Review Man software, version 5.3, for structuring the review. In the studies analyzed, considering symptomatic venous thromboembolism, rivaroxaban resulted in higher benefits when compared to enoxaparin.. A artroplastia total do joelho é um procedimento eletivo, realizado em indivíduos relativamente saudáveis. Porém, devido ao risco inerente de tromboembolismo venoso, são utilizados fármacos para sua profilaxia. O objetivo do presente trabalho foi conduzir uma revisão sistemática da literatura para comparar a eficácia da enoxaparina e da rivaroxabana na prevenção desta complicação e no risco de sangramento intraoperatório. Foi feita uma revisão no site SciELO, Pubmed e Cochrane através dos descritores, artroplastia de joelho, rivaroxabana e enoxaparina através da estratégia de busca PICO. Os critérios de inclusão foram os artigos no período estudado, que comparavam ambas as drogas em cirurgias de artroplastia do joelho. Os critérios de relevância para tornar o estudo elegível foram definidos como: somente artigos publicados a partir 2010 e com casuística com mais de 20 pacientes foram considerados; somente estudos obtidos em sua íntegra foram analisados; somente estudos com seguimento maior do que 12 meses foram considerados relevantes. As variáveis utilizadas para a comparação dos artigos foram as complicações mais comuns no pós-operatório de artroplastias do joelho: tromboembolismo venoso e sangramento. Foi utilizado o Review Man 5.3 para estruturação da revisão. Os autores observaram que nos estudos analisados, considerando tromboembolismo venoso sintomático, a rivaroxabana resultou em maiores benefícios quando comparada com a enoxaparina.

Topics: Anticoagulants; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Enoxaparin; Humans; Postoperative Complications; Postoperative Hemorrhage; Risk Factors; Rivaroxaban; Treatment Outcome; Venous Thromboembolism

The purpose of this review was to offer practical management strategies for when patients receiving direct oral anticoagulants require elective surgery or present with bleeding complications.. Clinical practice guidelines are now available on the timing of periprocedural interruption of treatment with the newer direct oral anticoagulants based on their pharmacodynamics and pharmacokinetics and based on findings from cohort studies and clinical trials. An antibody that reverses the effects of dabigatran is now available, and a factor Xa decoy is being developed as an antidote to apixaban, betrixaban, edoxaban, and rivaroxaban. The timing of interruption of direct oral anticoagulants for elective surgery is based on multiple factors, including pharmacologic properties and interactions, the patient's renal function, and the type of planned surgery. There is little role for low-molecular-weight heparin bridging. Idarucizumab is the treatment of choice for dabigatran-related life-threatening bleeding, while andexanet alfa is being developed to reverse factor Xa inhibitors.

Topics: Administration, Oral; Antibodies, Monoclonal, Humanized; Anticoagulants; Antidotes; Antithrombins; Benzamides; Blood Loss, Surgical; Dabigatran; Deprescriptions; Elective Surgical Procedures; Factor Xa; Factor Xa Inhibitors; Hemorrhage; Humans; Practice Guidelines as Topic; Pyrazoles; Pyridines; Pyridones; Recombinant Proteins; Rivaroxaban; Thiazoles

Many patients under oral anticoagulation therapy need percutaneous or surgical interventions/operations. For vitamin K antagonists (VKA), there are recommendations regarding preoperative or postoperative administration. Management of the new oral anticoagulants (NOAC) was supposed to be easier - but some aspects must be considered. Due to the different pharmacokinetic profiles of substances such as dabigatran, rivaroxaban, apixaban, and edoxaban, different recommendations are given.Upon periprocedural management, thromboembolic risk has to be considered in patients treated with NOACs. NOACS have a pharmacokinetic advantage in terms of a rapid onset and rapid elimination via the liver and kidneys. Impaired renal function results in extended half-life of NOACs considerably.Surgical procedures under NOACS can be scheduled at the beginning of next dosing interval or omitted in low/minimal bleeding risk patients, so that only 2-3 NOAC doses are not administered. In patients with moderate and high risk of bleeding, there should be a NOAC break of 24-48 h prior to surgery in order to allow a corresponding decay of the active metabolite. In patients with low/intermediate risk for thromboembolism, no bridging is necessary if the "unprotected" time (NOAC break) is less than 4-5-(7) days. In patients at high risk of thromboembolism, individual consideration must be taken regarding bridging or extended NOAC break. Whether NOACs can be dispensed or bridging is necessary in these patients must be clarified in randomized trials for periprocedural management of NOACs patients.

Topics: Administration, Oral; Antibodies, Monoclonal, Humanized; Anticoagulants; Blood Loss, Surgical; Dabigatran; Drug Interactions; Half-Life; Humans; Pyrazoles; Pyridines; Pyridones; Rivaroxaban; Surgical Procedures, Operative; Thiazoles; Thromboembolism; Vitamin K

Anticoagulants can complicate the approach to the management of patients undergoing operative interventions. We review new anticoagulants that have been introduced recently to the market or that are undergoing investigations for treatment of nonvalvular atrial fibrillation and venous thromboembolism prophylaxis: Dabigatran, rivaroxaban, apixiban, and edoxaban.

Topics: Anticoagulants; Atrial Fibrillation; Benzimidazoles; beta-Alanine; Blood Loss, Surgical; Clinical Trials as Topic; Dabigatran; Humans; Morpholines; Pyrazoles; Pyridines; Pyridones; Rivaroxaban; Stroke; Surgical Procedures, Operative; Thiazoles; Thiophenes; Venous Thromboembolism; Warfarin

Because of the characteristics of direct oral anticoagulants (DOA), the lack of an antidote to completely reverse their anticoagulant effects, the absence of standardization in monitoring of their effects, and limited experience of their use, specific recommendations for their management in the perioperative period or in emergencies are required. In elective surgery, in patients with normal renal function and low hemorrhagic/ thrombotic risk, DOA should be withdrawn 2 days before the intervention; when the hemorrhagic/ thrombotic risk is higher, bridge therapy with a low molecular weight hepatin beginning 5 days before the intervention is proposed as an alternative. In emergency surgery, systematic administration of hemostatic drugs as prophylaxis is not recommended. In DOA-related acute hemorrhage, administration of prothrombin complex concentrate, fresh plasma or factor VIIa should be evaluated, and general measures to control bleeding should be implemented.

Topics: Administration, Oral; Anticoagulants; Benzimidazoles; beta-Alanine; Blood Loss, Surgical; Dabigatran; Humans; Morpholines; Perioperative Care; Postoperative Hemorrhage; Practice Guidelines as Topic; Pyrazoles; Pyridones; Rivaroxaban; Thiophenes; Venous Thromboembolism; Withholding Treatment

A number of novel oral anticoagulants that directly target factor Xa or thrombin have been developed in recent years. Rivaroxaban and apixaban (direct factor Xa inhibitors) and dabigatran etexilate (a direct thrombin inhibitor) have shown considerable promise in large-scale, randomised clinical studies for the management of thromboembolic disorders, and have been approved for clinical use in specific indications. Rivaroxaban is licensed for the prevention of venous thromboembolism in patients undergoing elective hip or knee replacement surgery, the treatment of deep-vein thrombosis and prevention of recurrent venous thromboembolism, and for stroke prevention in patients with non-valvular atrial fibrillation. Based on the clinical trial data for rivaroxaban, feedback on its use in clinical practice and the authors' experience with the use of rivaroxaban, practical guidance for the use of rivaroxaban in special patient populations and specific clinical situations is provided. Although most recommendations are in line with the European summary of product characteristics for the approved indications, additional and, in several areas, different recommendations are given based on review of the literature and the authors' clinical experience.

Topics: Anticoagulants; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Atrial Fibrillation; Benzimidazoles; beta-Alanine; Blood Loss, Surgical; Clinical Trials as Topic; Dabigatran; Factor Xa Inhibitors; Female; Humans; Male; Morpholines; Practice Guidelines as Topic; Pregnancy; Rivaroxaban; Stroke; Thiophenes; Venous Thromboembolism; Venous Thrombosis; Warfarin

Tranexamic acid (TXA) has been widely applied in total knee arthroplasty (TKA) to significantly reduce perioperative blood loss and improve knee function recovery in patients after surgery. The choice of antithrombotic agents for venous thromboembolism (VTE) prevention after TKA is controversial. Therefore, this study aimed to compare the effects of different antithrombotic agents on patients after primary unilateral TKA in the context of applied TXA.. A total of 180 patients undergoing primary unilateral TKA from October 2020 to December 2021 were included in this study. All patients were given an intraoperative drip of 60 mg/kg TXA. Thereafter, patients were divided into three groups (n = 60 each). Baseline data were comparable among the three groups. The average follow-up time was 3.02 ± 0.09 months. Group 1 enrolled patients receiving oral rivaroxaban (RA) at 10 mg, Group 2 included patients who received subcutaneous Dalteparin sodium at 2500 IU, while Group 3 included patients taking oral aspirin (ASA) at 100 mg. Patients in all the three groups received treatment once a day for 30 days at 12 h postoperatively. The primary outcomes in this study were post-treatment drainage volume and thrombotic complication rate. The secondary outcomes included hematologic parameters, transfusion rate, intraoperative blood loss, total blood loss (TBL), and bleeding complication rate.. The average drainage volume after treatment was significantly lower in Group 3 than in Group 1 and Group 2 (205.2 ± 69.0 vs 243.4 ± 72.5 vs 295.4 ± 72.5 ml, P < 0.001), and there was a significant difference between Group 1 and Group 2 (243.4 ± 72.5 mL vs 295.4 ± 72.5 mL, P < 0.001). The blood transfusion rate of Group 2 dramatically increased compared with Group 1 and Group 3 (20.0% vs 6.7% vs 5.0%, P = 0.01). The bleeding complication rate in Group 1 apparently increased relative to Group 2 and Group 3 (26.7% vs 10.0% vs 8.3%, P = 0.008). Besides, there was no significant difference in the thrombotic complication rate among the three groups.. Under the background of TXA application, ASA, RA, and Dalteparin sodium were all effective on preventing VTE after TKA. In addition, ASA effectively reduced post-treatment Hemoglobin (Hb) loss, drainage volume, TBL, transfusion rate, and bleeding complications compared with RA and Dalteparin sodium.. The trial was registered at the Chinese Clinical Trial Registry (ChiCTR2200060169). Date of Registration: 21/05/2022.

Topics: Anticoagulants; Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Dalteparin; Fibrinolytic Agents; Humans; Postoperative Hemorrhage; Prospective Studies; Rivaroxaban; Tranexamic Acid; Venous Thromboembolism

This study investigates the impact of preoperative calculated rivaroxaban (RXA) plasma concentration on perioperative red blood cell (RBC) loss.. In this retrospective single-center study, we identified patients with RXA intake according to a preoperative determination of RXA levels within 96 hours before surgery. RXA plasma concentration at the beginning of surgery was then calculated from the last RXA intake using a single-compartment pharmacokinetic model with four categories of RXA concentration (≤20, 21-50, 51-100, and >100 μg/L). Patients were classified into surgery with high (≥500 mL) or low (<500 mL) expected blood loss. Perioperative bleeding was determined by calculating RBC loss.. We analyzed 308 surgical interventions in 298 patients during the period from January 2012 to July 2018. Among patients undergoing surgery with low expected blood loss, RBC loss varied from 164 mL (standard deviation [SD], 189) to 302 mL (SD, 397) (p = 0.66), and no association of calculated RXA concentration with RBC loss was observed. In patients undergoing surgery with high expected blood loss, we found a significant correlation of calculated RXA concentration with RBC loss (Pearson's correlation coefficient, 0.29; p = 0.002). RBC loss increased with rising RXA concentration from 575 mL (SD, 365) at RXA concentration of 20 μg/L or less up to 1400 mL (SD, 1300) at RXA concentration greater than 100 μg/L. RXA concentration greater than 100 μg/L was associated with a significant increase of in RBC loss of 840 mL (95% confidence interval, 360-1300; p < 0.001). Transfusion of RBC and fresh frozen plasma units tended to increase in patients with RXA concentrations greater than 100 μg/L. The proportion of patients treated with prothrombin complex concentrate and coagulation factor XIII concentrate increased significantly with higher RXA concentrations.. Only in surgery with high expected blood loss, a calculated RXA concentration of greater than 100 μg/L was associated with a significant increase of perioperative RBC loss.

Topics: Aged; Aged, 80 and over; Blood Loss, Surgical; Erythrocyte Transfusion; Female; Humans; Male; Middle Aged; Plasma; Retrospective Studies; Rivaroxaban; Surgical Procedures, Operative

This prospective, stratified, randomized, single-blind, placebo-controlled multicentre study investigated the safety and effectiveness of reducing blood loss and preventing venous thromboembolism (VTE) during posterior lumbar interbody fusion (PLIF) in patients with stenosis or spondylolisthesis using the combination of tranexamic acid (TXA) and rivaroxaban.. The Autar score was evaluated in patients after admission. Patients with an Autar score ≤ 10 were randomized to group A or B. Group A was the placebo-controlled group. Patients in group B were treated with 1 g TXA via intravenous injection and 1 g TXA for external use. Patients with an Autar score > 10 were randomized to group C or D. Patients in group C were treated with 10-mg rivaroxaban qd for 35 days after surgery. Patients in group D received the same treatment as those in group B intra-operatively and as those in group C post-operatively.. A total of 599 patients from eight hospitals participated in this clinical trial. The total blood loss, intra-operative blood loss, and drainage volume were reduced by the administration of TXA (group A vs group B, P < 0.01; group C vs group D, P < 0.01), and the blood transfusion rate was also decreased (group A vs group B, P < 0.01; group C vs group D, P < 0.01). There were no significant differences (P > 0.05) in the VTE incidence rates among group A and group B. In patients with high-risk thrombosis, the number of patients with VTE was only three and seven after the application of rivaroxaban. Epidural haematoma was not discovered in any patients in our trial.. The combined application of tranexamic acid and rivaroxaban significantly reduced the amount of blood loss and the transfusion rate during PLIF surgery and avoided an increase in the probability of thrombosis and the occurrence of epidural haematoma.. ChiCTR-1800016430 2018-06-01.

Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Blood Transfusion; Humans; Prospective Studies; Rivaroxaban; Single-Blind Method; Thrombosis; Tranexamic Acid; Treatment Outcome

To evaluate the efficacy of the combined intravenous and intra-articular administration of tranexamic acid (TXA) to control the collateral effects and complications of rivaroxaban (RIV) after total knee arthroplasty (TKA) and to compare thromboprophylaxis schemes with and without TXA, RIV and low molecular weight heparin (LMWH).. We prospectively studied 158 TKA patients from 2014 to 2018. The patients were randomly assigned into three groups. Group A (46 patients) was administered intravenous and intra-articular TXA and RIV postoperatively; group B (58 patients) was administered TXA as in group A and LMWH postoperatively; and group C (54 patients) was administered saline as in group A and RIV postoperatively. We evaluated blood loss, transfusion requirements and hemorrhagic complications.. Hct and Hb values significantly decreased in group C compared to groups A and B, without any difference between groups A and B. Suction drain blood volume output was significantly higher in group C compared to group A and B, without any difference between group A and B. Hemorrhagic complications were more common in group C. No patient experienced clinical findings of VTE.. Combined intravenous and intra-articular administration of TXA is safe and effective in TKA, with fewer hemorrhagic complications compared to placebo. Thromboprophylaxis with RIV and LMWH is similar.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Blood Transfusion; Drug Therapy, Combination; Female; Heparin, Low-Molecular-Weight; Humans; Infusions, Intravenous; Injections, Intra-Articular; Male; Middle Aged; Postoperative Hemorrhage; Prospective Studies; Rivaroxaban; Tranexamic Acid; Treatment Outcome; Venous Thromboembolism

Cementless primary total hip arthroplasty (THA) is associated with risks of bleeding and thromboembolism. Anticoagulants are effective as venous thromboprophylaxis, but with an increased risk of bleeding. Tranexamic acid (TXA) is an efficient antifibrinolytic agent, but the mode and timing of its administration remain controversial. This study aimed to determine whether two intravenous (IV) TXA regimens (a three-hour two-dose (short-TXA) and 11-hour four-dose (long-TXA)) were more effective than placebo in reducing perioperative real blood loss (RBL, between baseline and day 3 postoperatively) in patients undergoing THA who receive rivaroxaban as thromboprophylaxis. The secondary aim was to assess the non-inferiority of the reduction of blood loss of the short protocol versus the long protocol.. A multicentre, prospective, randomized, double-blind, placebo-controlled trial was undertaken involving 229 patients undergoing primary cementless THA using a posterior approach, whose extended rivaroxaban thromboprophylaxis started on the day of surgery. There were 98 male and 131 female patients, with a mean age of 65.5 years (32 to 91). The primary outcome, perioperative RBL, was evaluated at 72 hours postoperatively. The efficacy of short- and long-TXA protocols in the reduction of perioperative RBL was compared with a placebo group.. TXA significantly reduced perioperative blood loss compared with placebo (p < 0.001); the mean differences were 525.3 ml (short-TXA vs placebo) and 550.1 ml (long-TXA vs placebo). No venous or arterial thromboembolic complications were reported. The upper boundary of the 95% confidence interval, when comparing short and long protocols, was below the pre-specified margin of non-inferiority (p = 0.027).. In patients undergoing primary cementless THA, using a posterior approach, who are treated with rivaroxaban for thromboembolic prophylaxis, short- and long-TXA IV protocols are significantly more effective than placebo in reducing perioperative RBL, without any thromboembolic complications. Non-inferiority of a short- versus a long-TXA protocol in reducing perioperative RBL was supported in a secondary analysis.

Topics: Adult; Aged; Aged, 80 and over; Antifibrinolytic Agents; Arthroplasty, Replacement, Hip; Blood Loss, Surgical; Bone Cements; Cementation; Chemoprevention; Double-Blind Method; Factor Xa Inhibitors; Female; Hematologic Agents; Hip Joint; Humans; Joint Diseases; Male; Middle Aged; Prospective Studies; Rivaroxaban; Tranexamic Acid; Treatment Outcome

It is unclear whether topical (intra-articular) or intravenous TXA reduces blood loss in minimally invasive TKA patients receiving a direct oral anticoagulant for thromboprophylaxis. This study is to investigate whether TXA given intravenously or intra-articularly is effective in reducing blood loss in minimally invasive TKA patients using rivaroxaban for thromboprophylaxis.. Ninety-three patients who underwent primary minimally invasive TKA were divided into placebo group (30 patients) that received saline both intravenously and intra-articularly, intravenous (IV) group (31 patients) that received 1 g TXA intravenously, and topical group (32 patients) that received 3 g TXA in 100 ml saline intra-articularly. All patients received oral rivaroxaban of 10 mg daily for 14 days postoperatively.. This prospective, randomized, controlled trial demonstrated an equal efficacy of TXA in blood conservation when administered intravenously or topically in minimally invasive TKA patients receiving rivaroxaban for thromboprophylaxis.

Topics: Administration, Topical; Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Female; Humans; Male; Middle Aged; Minimally Invasive Surgical Procedures; Postoperative Care; Rivaroxaban; Tranexamic Acid; Treatment Outcome

Tranexamic acid (TXA) was reportedly to decrease postoperative blood loss after standard total knee arthroplasty (TKA). However, the blood-conservation effect of TXA in minimally invasive TKA, in particular, receiving a direct oral anticoagulant was unclear. The aim of the study was to investigate the efficacy of combined use of TXA and rivaroxaban on postoperative blood loss in primary minimally invasive TKA.. In a prospective, randomized, controlled trial, 198 patients were assigned to placebo (98 patients, normal saline injection) and study group (100 patients, 1g TXA intraoperative injection) during primary unilateral minimally invasive TKA. All patients received rivaroxaban 10 mg each day for 14 doses postoperatively. Total blood loss was calculated from the maximum hemoglobin drop after surgery plus amount of transfusion. The transfusion rate and wound complications were recorded in all patients. Deep-vein thrombosis was detected by ascending venography of the leg 15 days postoperatively.. The mean total blood loss was lower in the study group (1020 mL [95% confidence interval, 960-1080 mL]) compared with placebo (1202 mL [95% confidence interval, 1137-1268 mL]) (P < .001). The transfusion rate was lower in the study group compared with placebo (1% vs 8.2%, P = .018). Postoperative wound hematoma and ecchymosis were higher in placebo than the study group (P = .003). There was no symptomatic deep-vein thrombosis or pulmonary embolism in either group.. Systemic administration of TXA can effectively reduce the postoperative blood loss which results in lower rate of transfusion requirement and wound hematoma in minimally invasive TKA patients when rivaroxaban is used for thromboprophylaxis. Rivaroxaban has a high rate of bleeding complications when used alone in TKA patients.

Topics: Aged; Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Blood Transfusion; Double-Blind Method; Drug Therapy, Combination; Factor Xa Inhibitors; Female; Hematoma; Humans; Male; Middle Aged; Morpholines; Postoperative Hemorrhage; Postoperative Period; Prospective Studies; Pulmonary Embolism; Rivaroxaban; Thiophenes; Tranexamic Acid; Venous Thrombosis

Our study is aimed to explore effects of five treatment regimens on blood loss and blood transfusion rate in total knee arthroplasty (TKA) patients.. 191 TKA patients were divided into the rivaroxaban, nadroparin, and tranexamic acid groups (n = 37 each) as well as into the affected-limb-position and tourniquet group (n = 40 each). A 3-month follow-up after operation was needed for all patients. The total blood loss, hidden blood loss, and dominant blood loss were recorded, and hemoglobin and red blood cell changes, pain and knee swelling degrees, hospital for special surgery (HSS), and American knee society (KSS) knee scores were observed.. When compared with the rivaroxaban, nadroparin, and tourniquet groups, TKA patients' dominant blood loss, hidden blood loss, total blood loss, rate and volume of blood transfusion in the tranexamic acid and affected-limb-position groups were significantly decreased. While 7 days after operation, the hemoglobin and red blood cells in the tranexamic acid and affected-limb-position groups were significantly increased. At 1 month and 3 months after operation, when compared with the rivaroxaban, nadroparin, and tourniquet groups, the HSS and KSS scores in the tranexamic acid and affected-limb-position groups were all increased. In comparison with the rivaroxaban, nadroparin, and tourniquet groups, the D-Dimers after operation in the tranexamic acid and affected-limb-position groups were significantly lower.. These results demonstrated that for TKA patients, the tranexamic acid and affected-limb-position could obviously reduce the blood loss and blood transfusion rate.
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Topics: Aged; Anticoagulants; Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Biomarkers; Blood Loss, Surgical; Blood Transfusion; China; Factor Xa Inhibitors; Female; Hemoglobins; Humans; Male; Middle Aged; Nadroparin; Patient Positioning; Postoperative Hemorrhage; Rivaroxaban; Time Factors; Tourniquets; Tranexamic Acid; Treatment Outcome

VENTURE-AF is the first prospective randomized trial of uninterrupted rivaroxaban and vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation (NVAF) undergoing catheter ablation (CA).. Trial size was administratively set at 250, the protocol-specified target. Events were independently and blindly adjudicated. We randomly assigned 248 NVAF patients to uninterrupted rivaroxaban (20 mg once-daily) or to an uninterrupted VKA prior to CA and for 4 weeks afterwards. The primary endpoint was major bleeding events after CA. Secondary endpoints included thromboembolic events (composite of stroke, systemic embolism, myocardial infarction, and vascular death) and other bleeding or procedure-attributable events. Patients were 59.5 ± 10 years of age, 71% male, 74% paroxysmal AF, and had a CHA2DS2-VASc score of 1.6. The average total heparin dose used to manage activated clotting time (ACT) was slightly higher (13 871 vs. 10 964 units; P < 0.001) and the mean ACT level attained slightly lower (302 vs. 332 s; P < 0.001) in rivaroxaban and VKA arms, respectively. The incidence of major bleeding was low (0.4%; 1 major bleeding event). Similarly, thromboembolic events were low (0.8%; 1 ischemic stroke and 1 vascular death). All events occurred in the VKA arm and all after CA. The number of any adjudicated events (26 vs. 25), any bleeding events (21 vs. 18), and any other procedure-attributable events (5 vs. 5) were similar.. In patients undergoing CA for AF, the use of uninterrupted oral rivaroxaban was feasible and event rates were similar to those for uninterrupted VKA therapy.. Clinicaltrials.gov trial registration number is NCT01729871.

Topics: Anti-Arrhythmia Agents; Atrial Fibrillation; Blood Loss, Surgical; Catheter Ablation; Drug Administration Schedule; Factor Xa Inhibitors; Female; Humans; Male; Middle Aged; Operative Time; Prospective Studies; Pulmonary Veins; Recurrence; Reoperation; Rivaroxaban; Single-Blind Method; Treatment Outcome; Vitamin K

To study the effect of autologous drained blood reinfusion on hidden blood loss and limb swelling following rivaroxaban anticoagulation for primary total hip arthroplasty.. From May, 2011 to October, 2012, 98 patients undergoing primary unilateral total hip arthroplasty received rivaroxaban therapy for prevention of deep venous thrombosis (DVT). Forty-five of the patients used a drained blood reinfusion device (group A) and 53 patients did not (group B). Hidden blood loss and the maximal changes of postoperative circumferential length of the mid-thigh were measured and compared between the two groups.. The mean total blood loss, the hidden blood loss, and the maximal changes of postoperative thigh circumference were 1591.1∓337.3 ml, 1591.1∓337.3 ml, and 5.1∓2.8 cm in group A, as compared to 1374.5∓317.3 ml, 467∓96.8 ml, 3.9∓1.4 cm in group B, respectively. The two groups showed a significant difference in the maximal changes of postoperative mid-thigh circumference (P<0.01) but not in hidden blood loss (P>0.05).. Reinfusion of autologous drained blood does not affect hidden blood loss but can increase limb swelling following primary total hip arthroplasty with rivaroxaban anticoagulation.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Arthroplasty, Replacement, Hip; Blood Loss, Surgical; Blood Transfusion, Autologous; Edema; Female; Humans; Male; Middle Aged; Morpholines; Rivaroxaban; Thiophenes; Venous Thrombosis

Patients treated with direct Xa inhibitors may require urgent surgery. Administration of prothrombin complex concentrate (PCC) in this setting is common; however, it is based on limited experience in healthy volunteers.. To characterize the population receiving PCC for apixaban/rivaroxaban reversal prior to an urgent surgery and evaluate its efficacy and safety.. This was a retrospective study in 2 tertiary hospitals. Bleeding was evaluated based on surgical reports, hemoglobin drop, and the use of blood products or additional PCC during 48 h. Safety measures were thrombotic complications and 30-day mortality.. Sixty-two patients aged 80.7 ± 9 years, treated with apixaban (39.63%) or rivaroxaban (23.37%), received PCC before an urgent surgery/procedure. Most underwent abdominal operation (61%), orthopedic surgery (13%), or transhepatic cholecystostomy insertion (10%). Bleeding during surgery was reported in 3 patients (5%), no patient required additional PCC, and 16 patients (26%) received packed cells (median: 1 unit, range: 1-5). The 30-day mortality and thrombosis rates were 21% (n = 13) and 3% (n = 2), respectively. The cause of death was related to the primary disease, most commonly sepsis. No patient died due to bleeding/thrombosis.. Our results support the use of PCC to achieve hemostasis in patients treated with Xa inhibitors prior to an urgent surgery.

Topics: Academic Medical Centers; Aged; Aged, 80 and over; Atrial Fibrillation; Blood Coagulation Factors; Blood Component Transfusion; Blood Loss, Surgical; Emergencies; Factor Xa Inhibitors; Female; Hemostatics; Humans; Male; Postoperative Hemorrhage; Preoperative Care; Pyrazoles; Pyridones; Retrospective Studies; Rivaroxaban; Surgical Procedures, Operative; Tertiary Care Centers; Thrombophilia; Thrombosis; Tranexamic Acid

CytoSorb hemoadsorption (CytoSorbents Inc, Monmouth Junction, NJ) was performed shortly before an urgent off-pump coronary artery bypass operation in a 58-year-old man at high risk of bleeding as a result of treatment of coronary artery disease with ticagrelor and treatment of atrial fibrillation with rivaroxaban. The patient experienced dissection of the left anterior descending artery during a percutaneous coronary intervention. Preoperatively, CytoSorb hemoadsorption was applied to eliminate the coagulative active medications. His intraoperative and postoperative courses were uneventful, with adequate bleeding control. This case highlights a promising approach for managing antiplatelet drugs and anticoagulant agents such as ticagrelor and rivaroxaban before off-pump coronary artery bypass.

Topics: Blood Loss, Surgical; Coronary Artery Bypass, Off-Pump; Hemoperfusion; Humans; Male; Middle Aged; Rivaroxaban; Ticagrelor

Comparison of different anticoagulants in blood management and complications with tranexamic acid (TXA) in total hip arthroplasty (THA) is unclear. Our aim was to compare the efficacy and safety among receiving nadroparin calcium, enoxaparin sodium or rivaroxaban after TXA in THA.150 patients undergoing primary unilateral THA were received 15 mg/kg intravenous TXA (IV-TXA) before skin incision, followed by 1 of nadroparin calcium (Group A), enoxaparin sodium (Group B), or rivaroxaban (Group C) randomly during hospitalization. The primary outcome was hidden blood loss (HBL). Other outcomes such as the maximum hemoglobin (Hb) drop, total blood loss (TBL), the volume of drainage, transfusion rate, length of hospital stay (LOS), and complications were also compared.There were no statistically significant differences in HBL, the maximum hemoglobin (Hb) drop, transfusion rate, and complications among 3 groups. LOS was significantly higher for patients in Group B than Group A (P = .026). Neither deep venous thrombosis (DVT) nor pulmonary embolism (PE) occurred in any group.There were no differences in efficacy and safety in patients undergoing THA receiving nadroparin calcium, enoxaparin sodium, or rivaroxaban after anti-fibrinolysis with TXA.

Topics: Administration, Intravenous; Aged; Anticoagulants; Antifibrinolytic Agents; Arthroplasty, Replacement, Hip; Blood Loss, Surgical; Blood Transfusion; China; Enoxaparin; Female; Hemoglobins; Hospitalization; Humans; Length of Stay; Male; Middle Aged; Nadroparin; Occult Blood; Retrospective Studies; Rivaroxaban; Safety; Tranexamic Acid; Treatment Outcome

There is little data on management and outcomes of atrial fibrillation (AF) patients on direct oral anticoagulants (DOAC) undergoing general surgery.We retrospectively assessed 98 surgeries in 85 nonvalvular AF patients aged 73 ± 8 (59 men) receiving DOACs. Cardiac, emergency, and minimally invasive surgeries were excluded.The CHA

Topics: Aged; Aged, 80 and over; Antithrombins; Atrial Fibrillation; Blood Loss, Surgical; Carotid Artery Diseases; Cerebral Infarction; Dabigatran; Digestive System Surgical Procedures; Elective Surgical Procedures; Embolism; Endoscopy; Factor Xa Inhibitors; Female; Humans; Male; Myocardial Infarction; Orthopedic Procedures; Perioperative Care; Postoperative Complications; Postoperative Hemorrhage; Pyrazoles; Pyridines; Pyridones; Retrospective Studies; Rivaroxaban; Thiazoles; Thromboembolism; Urologic Surgical Procedures; Vascular Surgical Procedures

Topics: Aged; Atrial Fibrillation; Blood Loss, Surgical; Dabigatran; Elective Surgical Procedures; Factor Xa Inhibitors; Female; Hemorrhage; Humans; Male; Medication Therapy Management; Perioperative Care; Pyrazoles; Pyridones; Risk Adjustment; Rivaroxaban; Stroke

To evaluate the safety of phacoemulsification of cataract in patients taking new oral anticoagulants (NOACs).. In a prospective case series, consecutive patients on NOACs (dabigatran, rivaroxaban, or apixaban) who were referred for uncomplicated cataract surgery to the eye institute underwent a thorough ophthalmological and hematological evaluation. Rivaroxaban and apixaban anti-factor Xa tests, and diluted thrombin time for dabigatran, were used for monitoring anticoagulation levels in blood. Blood was drawn for these tests just prior to surgery and at a peak level of the drug at about 4 h post-surgery (2 h after the drug was given). All surgeries were videotaped and patients were examined at 1 and 7 days after the operation. The main outcome measures included assessment of intra-operative, postoperative ocular bleeding, and other related complications.. Thirty-five eyes of 25 unrelated patients ranging in age from 63 to 92 years (mean 77.6 years) underwent phacoemulsification. Intra-operative bleeding was observed in 5 eyes from the conjunctiva or limbus at the main incision site. No intraocular bleeding occurred. No hemorrhagic complications were observed during the 1-week follow-up. According to anti-factor Xa levels prior to surgery and following surgery, 85% of the patients were on therapeutic levels of NOACs.. Clear corneal incision phacoemulsification performed under topical anesthesia can be safely performed in simple cases of cataract without discontinuing NOAC treatment.

Topics: Administration, Oral; Aged; Aged, 80 and over; Antithrombins; Blood Loss, Surgical; Dabigatran; Eye Hemorrhage; Factor Xa Inhibitors; Female; Follow-Up Studies; Humans; Incidence; Israel; Male; Middle Aged; Phacoemulsification; Postoperative Hemorrhage; Prospective Studies; Pyrazoles; Pyridones; Rivaroxaban; Thromboembolism

Topics: Antidotes; Blood Coagulation Factors; Blood Component Transfusion; Blood Loss, Surgical; Cerebral Hemorrhage; Drug Administration Schedule; Emergencies; Factor Xa; Factor Xa Inhibitors; Hemorrhage; Humans; Intraoperative Care; Premedication; Preoperative Care; Pyrazoles; Pyridones; Recombinant Proteins; Rivaroxaban; Wounds and Injuries

Topics: Aged, 80 and over; Aortic Aneurysm, Thoracic; Aortic Dissection; Atrial Fibrillation; Blood Coagulation Factors; Blood Coagulation Tests; Blood Loss, Surgical; Blood Vessel Prosthesis Implantation; Blood Volume; Cardiopulmonary Bypass; Factor Xa Inhibitors; Female; Humans; Preoperative Care; Rivaroxaban; Treatment Outcome

Guidelines recommend the use of multiple pharmacologic agents and/or mechanical compressive devices for prevention of venous thromboembolism, but preference for any specific agent is no longer given in regard to safety or efficacy.. To compare postoperative bleeding rates in patients receiving enoxaparin, rivaroxaban, or aspirin for thromboprophylaxis after undergoing elective total hip arthroplasty or total knee arthroplasty.. This retrospective cohort analysis evaluated patients who received thromboprophylaxis with either enoxaparin, rivaroxaban, or aspirin. All data were collected from the electronic medical record. The primary outcome was any postoperative bleeding.. A total of 1244 patients were included with 366 in the aspirin, 438 in the enoxaparin, and 440 in the rivaroxaban arms. Those who received aspirin or enoxaparin were less likely to experience any bleeding compared to those patients who received rivaroxaban ( P < .05). There was also a lower rate of major bleeding in these groups, but the differences were not significant.. Aspirin and enoxaparin conferred similar bleeding risks, and both exhibited less bleeding than patients who received rivaroxaban.

Topics: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Aspirin; Blood Loss, Surgical; Enoxaparin; Female; Humans; Male; Middle Aged; Retrospective Studies; Rivaroxaban; Thrombosis

Blood loss and deep vein thrombosis (DVT) are important complications after total knee arthroplasty (TKA). Topical tranexamic acid (TXA) effectively reduces wound bleeding but may elevate the risk of DVT. In contrast, rivaroxaban potently prevents DVT but has been associated with bleeding complications. The simultaneous use of topical TXA and rivaroxaban in TKA has not been much investigated.. A retrospective cohort study was conducted with two consecutive groups of patients who underwent TKA. Intraoperatively, one group (RVTX group) received topical, intraarticular TXA, while the other (RV group) did not. Both groups were administered rivaroxaban postoperatively for 14 days and underwent Doppler ultrasound for DVT screening. After propensity score matching, both groups consisted of 52 patients (104 patients in total) and were compared regarding total drain output, nadir haemoglobin (Hb), maximum Hb decrease, calculated total blood loss, transfusion rate, and incidence of DVT and wound complications.. Both groups showed no significant differences in the propensity-matched variables of age, sex, body mass index, American Society of Anesthesiologists physical status score, and preoperative Hb. The RVTX group showed a significantly higher nadir Hb (p < 0.001), lower drain output (p < 0.001), Hb decrease (p = 0.015), total blood loss (p < 0.001), and rate of transfusion (p < 0.001) and fewer wound complications (p = 0.027). However, the incidence of DVT (p = 1.000) did not differ significantly between the two groups, and all cases were asymptomatic.. The combined use of intraarticular topical TXA with rivaroxaban in patients undergoing TKA is a safe and effective method to reduce blood loss, the need for transfusion, and wound complications without elevating the risk of DVT.

Topics: Administration, Topical; Aged; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Blood Transfusion; Drug Therapy, Combination; Factor Xa Inhibitors; Female; Follow-Up Studies; Humans; Male; Retrospective Studies; Risk Factors; Rivaroxaban; Surgical Wound Infection; Thrombosis; Tranexamic Acid

Osteoarthritis (OA) is the third most common diagnosis made by general practitioners in older patients. The purpose of the current study is to investigate effects rivaroxaban had on both hidden blood loss and blood transfusion rate (BTR) in patients with knee OA (KOA) after going through a total knee replacement (TKR).Between the time periods of December 2011 up until January 2015, a total of 235 patients underwent TKR and were selected to be assigned to either the rivaroxaban or nonanticoagulant groups. Coagulation function indexes before surgery and following administration of rivaroxaban, total blood loss, hidden blood loss, dominant blood loss, blood transfusion volume, hemoglobin reduction, degree of postoperative pain (visual analogue scale), the degree of knee swelling, and range of motion following surgery were all recorded. Hospital for special surgery (HSS) scores offered an objective evaluation for the knee joint functions before surgery at the intervals of 2 weeks and after surgery at intervals of 3 months, 6 months, 12 months, and 24 months.Patients in the rivaroxaban group had shown a higher hidden blood loss, as well as a higher BTR, compared to those involved in the nonanticoagulant group. BTR was found to have been 49.59% in the rivaroxaban group, and 35.09% for the nonanticoagulant group. Patients in the rivaroxaban group had lower degrees of knee swelling than those involved in the nonanticoagulant group. There was no deep vein thrombosis (DVT) detected in the rivaroxaban group, whereas 5 DVT cases were detected in the nonanticoagulant group. In the rivaroxaban group, the HSS scores of the knee joint functions were remarkably higher at the 2-week mark in succession to the surgery than those involved with the nonanticoagulant group.This overall data demonstrated that KOA patients after TKR had presented with a higher hidden blood loss, BRT, and lower swelling degrees of the knee joint after being treated by the rivaroxaban.

Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Blood Transfusion; Edema; Female; Humans; Male; Middle Aged; Osteoarthritis, Knee; Pain, Postoperative; Range of Motion, Articular; Rivaroxaban; Venous Thrombosis

Topics: Administration, Oral; Anticoagulants; Antithrombins; Blood Loss, Surgical; Cataract Extraction; Dabigatran; Eye Hemorrhage; Factor Xa Inhibitors; Humans; Pyrazoles; Pyridones; Rivaroxaban; Warfarin

Preventing venous thromboembolism (VTE) remains an important topic in the plastic surgery community. However, there is little consensus regarding appropriate VTE prophylaxis for patients undergoing common body contouring procedures.. This study compared the use of two novel oral anticoagulants (Rivaroxaban and Apixiban) vs low molecular weight heparin (LMWH) for postoperative chemical prophylaxis in body contouring plastic surgery procedures.. A single center retrospective chart review of 1572 patients who underwent body contouring plastic surgery procedures from January 2012 to February 2015 was performed. Major complications associated with chemical prophylaxis were reviewed including hematomas requiring surgical evacuation, acute blood loss anemia requiring transfusions, and thrombotic or hemorrhagic events.. Drug-related adverse events occurred in 1.27% (n = 20) of patients. The complications encountered by the 454 patients on LMWH consisted of 0.88% (n = 4) with hematomas requiring surgical evacuation, 0.44% (n = 2) with decreased hemoglobin requiring transfusions, and 0.22% (n = 1) with a deep vein thrombosis (DVT). The complications encountered by 703 patients on with Rivaroxaban consisted of 1.3% (n = 9) with hematomas requiring surgical evacuation, 0.43% (n = 3) with decreased hemoglobin requiring transfusions, and 0.1% (n = 1) with a DVT and pulmonary embolism. The complications encountered by 415 patients on with Apixaban consisted of 0.48% (n = 2) with a DVT.. Novel oral anticoagulants (Rivaroxaban and Apixiban) are comparable to LMWH for chemical prophylaxis after body contouring procedures with similar rates of drug-related complications. Further investigation is warranted with more clinical cases in order to recommend the use of this medication for routine postoperative chemical prophylaxis after body contouring procedures.. 3 Therapeutic.

Topics: Administration, Oral; Adolescent; Adult; Aged; Anticoagulants; Blood Loss, Surgical; Blood Transfusion; Factor Xa Inhibitors; Female; Hematoma; Heparin, Low-Molecular-Weight; Humans; Lipectomy; Male; Middle Aged; Postoperative Hemorrhage; Pyrazoles; Pyridones; Retrospective Studies; Risk Factors; Rivaroxaban; Texas; Treatment Outcome; Venous Thromboembolism; Young Adult

Topics: Administration, Oral; Antibodies, Monoclonal, Humanized; Antithrombins; Blood Loss, Surgical; Cerebral Hemorrhage; Clinical Trials as Topic; Dabigatran; Drug Approval; Emergencies; Factor Xa; Factor Xa Inhibitors; Hemorrhage; Humans; Pyrazoles; Pyridines; Pyridones; Recombinant Proteins; Rivaroxaban; Thiazoles; United States; United States Food and Drug Administration

Topics: Atrial Fibrillation; Blood Loss, Surgical; Catheter Ablation; Factor Xa Inhibitors; Female; Humans; Male; Rivaroxaban; Vitamin K

Topics: Antibodies, Monoclonal, Humanized; Anticoagulants; Arthroscopy; Blood Loss, Surgical; Dabigatran; Factor VIII; Hemophilia A; Humans; Randomized Controlled Trials as Topic; Rivaroxaban; Single-Domain Antibodies; Venous Thromboembolism

To compare the effect on blood loss after total knee arthroplasty (TKA) between rivaroxaban and enoxaparin.. A retrospective analysis was made on the clinical data of 107 patients (121 knees) with osteoarthritis undergoing primary TKA between January 2010 and October 2012. According to different perioperative anticoagulants, the patients were divided into the rivaroxaban group (51 cases, 57 knees) and the enoxaparin group (56 cases, 64 knees). There was no significant difference in gender, age, height, weight, body mass index, osteoarthritis classification, and disease duration between 2 groups (P > 0.05). The total blood loss, hidden blood loss, dominant blood loss, and the percentage of hidden blood loss were compared between 2 groups. The bleeding events were recorded within 35 days after operation.. The dominant blood loss of enoxaparin group was significantly higher than that of rivaroxaban group (t = 3.025, P = 0.003), but the percentage of hidden blood loss of enoxaparin group was significantly lower than that of rivaroxaban group (t = 4.361, P = 0.000); no significant difference was found in the total blood loss and hidden blood loss between 2 groups (P > 0.05). The incidence of bleeding event in rivaroxaban group (15.69%; including 1 case of incision bleeding, 4 cases of melena, and 3 cases of haematuria) was significantly higher than that in enoxaparin group (3.57%; including 1 case of haematuria and 1 case of melena) (chi2 = 4.624, P = 0.032).. Rivaroxaban does not increase the risk of hidden blood loss for TKA when compared with enoxaparin, but enoxaparin can increase the risk of dominant blood.

Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Blood Volume; Enoxaparin; Female; Humans; Male; Middle Aged; Morpholines; Osteoarthritis, Knee; Postoperative Complications; Retrospective Studies; Risk Factors; Rivaroxaban; Thiophenes; Treatment Outcome

The periprocedural management of patients receiving long-term oral anticoagulant therapy is a common but complex clinical problem. It is well established that maintaining oral anticoagulation is associated with an increased risk of bleeding in the periprocedural period while discontinuing anticoagulant therapy postoperatively leads to an elevated risk for thromboembolic events, especially in high risk patients. Nowadays there is growing evidence to maintain antiplatelet therapy with acetylsalicylic acid (ASS, Aspirin®) perioperatively in a setting of secondary prophylaxis. Beyond that the increasing routine clinical use of novel oral anticoagulants (NOACs), such as the direct factor IIa inhibitor dabigatran and the direct factor Xa inhibitors rivaroxaban and apixaban, presents a challenge for urological surgeons. These agents are approved in patients with nonvalvular atrial fibrillation (rivaroxaban, dabigatran and apixaban) and in patients after deep vein thrombosis and pulmonary embolism (rivaroxaban). Due to their relatively short elimination half-lives and rapid onset of action, these new drugs have the potential to simplify periprocedural anticoagulant management making heparin bridging therapy redundant. Critical consideration is necessary regarding potential pitfalls, such as impaired renal function, insufficient possibility of laboratory monitoring and lack of antidotes in cases of postoperative hemorrhage. Although periprocedural protocols for the use of NOACs are emerging, robust clinical data are still scarce. This article provides a practical, clinician-focused approach to periprocedural management of NOACs.

Topics: Administration, Oral; Anticoagulants; Benzimidazoles; beta-Alanine; Blood Loss, Surgical; Dabigatran; Humans; Morpholines; Postoperative Hemorrhage; Premedication; Pyrazoles; Pyridones; Rivaroxaban; Thiophenes; Treatment Outcome; Urologic Surgical Procedures

New oral anticoagulants (NOAC) are becoming available as alternatives to warfarin to prevent systemic embolism in patients with non-valvular atrial fibrillation and for the treatment and prevention of venous thromboembolism. An in-depth understanding of their pharmacology is invaluable for appropriate prescription and optimal management of patients receiving these drugs should unexpected complications (such as bleeding) occur, or the patient requires urgent surgery. The Australasian Society of Thrombosis and Haemostasis has set out to inform physicians on the use of the different NOAC based on current available evidence focusing on: (i) selection of the most suitable patient groups to receive NOAC, (ii) laboratory measurements of NOAC in appropriate circumstances and (iii) management of patients taking NOAC in the perioperative period, and strategies to manage bleeding complications or 'reverse' the anticoagulant effects for urgent invasive procedures.

Topics: Administration, Oral; Anticoagulants; Atrial Fibrillation; Benzimidazoles; beta-Alanine; Blood Coagulation Tests; Blood Loss, Surgical; Contraindications; Dabigatran; Drug Interactions; Drug Monitoring; Drug Substitution; Elective Surgical Procedures; Emergencies; Hematoma, Epidural, Spinal; Hemorrhage; Humans; Kidney Diseases; Liver Diseases; Morpholines; Patient Selection; Pyrazoles; Pyridones; Rivaroxaban; Stroke; Thiophenes; Thrombophilia

To describe the pharmacologic agents and strategies used for urgent reversal of warfarin and the target-specific oral anticoagulants dabigatran, rivaroxaban, and apixaban.. To reverse the anticoagulant effects of warfarin in patients who are bleeding or need surgery, exogenous vitamin K (phytonadione) may be used in combination with another, shorter-acting intervention, such as fresh frozen plasma (FFP), prothrombin complex concentrate (PCC), recombinant factor VIIa, or activated PCC (aPCC). Three-factor PCC contains factors II, IX, and X in an inactivated form, and four-factor PCC also includes factor VII in an inactivated form. No four-factor PCC products are available in the United States, but aPCC, which contains the same four factors with factor VII provided in an activated form, is available. The intervention depends on the International Normalized Ratio, presence of bleeding, and need for and timing of surgery. Research suggests that clotting factor concentrates are more effective than FFP alone for warfarin reversal. These products also may be useful for reversing the effects of target-specific oral anticoagulants, but limited efficacy and safety data are available to support their use. The risks and benefits associated with these products need to be weighed before their use for reversal of dabigatran, rivaroxaban, or apixaban. Additional clinical data are needed to clearly define the role of concentrated clotting factor products in reversal and to determine the optimal clotting factor concentrate product and dose for urgent reversal of oral anticoagulation.. Phytonadione and clotting factor concentrates appear to have a role for reversal of warfarin, and limited evidence suggests that clotting factor concentrates could have a role in reversal of target-specific oral anticoagulants in an emergency situation.

Topics: Administration, Oral; Anticoagulants; Antifibrinolytic Agents; Antithrombins; Benzimidazoles; beta-Alanine; Blood Coagulation Factors; Blood Loss, Surgical; Dabigatran; Drug Therapy, Combination; Emergencies; Hemorrhage; Humans; International Normalized Ratio; Morpholines; Plasma; Pyrazoles; Pyridones; Rivaroxaban; Surgical Procedures, Operative; Thiophenes; Thromboembolism; Treatment Outcome; Vitamin K 1; Warfarin

To compare the effects of rivaroxaban and enoxaparin on hidden blood loss after total hip arthroplasty (THA).. A retrospective analysis was made on the clinical data of 76 patients (93 hips) with avascular necrosis of the femoral head who underwent primary THA between June 2009 and January 2012. After operation, 10 mg rivaroxaban was used at 6-10 hours for 14 days in 44 cases (54 hips) (rivaroxaban group) and 4 000 U enoxaparin at 12 hours for 14 days in 32 cases (39 hips) (enoxaparin group). There was no significant difference in age, gender, weight, height, disease duration, grade of avascular necrosis of the femoral head, and lesion hips between 2 groups (P > 0.05). The total blood loss, dominant blood loss, hidden blood loss, and percentage of hidden blood loss were calculated according to the formula. The bleeding events were recorded within 35 days after operation.. The total blood loss was (1 509.56 +/- 325.23) mL; the dominant blood loss was (928.09 +/- 210.50) mL; the hidden blood loss was (581.47 +/- 215.01) mL; and the percentage of hidden blood loss was 37.88% +/- 10.42% in the rivaroxaban group. The total blood loss was (1 521.38 +/- 516.49) mL; the dominant blood loss was (917.50 +/- 378.73) mL, the hidden blood loss was (603.88 +/- 377.15) mL, and the percentage of hidden blood loss was 38.18% +/- 18.33% in the enoxaparin group. There was no significant difference in the above indicators between 2 groups (P > 0.05). The incidence of bleeding event was 9.1% (4/44) in the rivaroxaban group and was 3.1% (1/32) in the enoxaparin group, showing no significant difference (Chi2=1.073, P=0.390).. There is no significant difference in the risk of hidden blood loss and incidence of bleeding event for primary THA between the rivaroxaban and the enoxaparin use.

Topics: Administration, Oral; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Blood Loss, Surgical; Blood Volume; Enoxaparin; Female; Femur Head Necrosis; Humans; Injections, Subcutaneous; Male; Middle Aged; Morpholines; Postoperative Complications; Postoperative Hemorrhage; Retrospective Studies; Rivaroxaban; Thiophenes; Young Adult

Guidelines concerning the prevention and treatment of pregnancy-associated venous thromboembolism (VTE) have been elaborated by the American College of Chest Physicians and published in Chest in 2008. In this review, they have been compared with European guidelines and discussed taking into account the papers published since 2008.Most recommendations are of low grade of evidence because randomized studies are lacking during pregnancy and many reflect guidelines proposed by experts. The decisions on the most appropriate prophylaxis, dose to be administered and moment of pregnancy for starting prophylaxis are often decided case by case after careful assessment of the risk of pregnancy-associated VTE, on one hand, and the risk for the mother, on the other.Risk factors (age >or= 35, obesity, history of VTE with or without sequellae, in vitro fertilization)or thrombophilia have to be taken into account. Scores have been proposed to improve standardisation and evaluation of the risk of VTE and they should be validated.

Topics: Abnormalities, Drug-Induced; Adult; Anticoagulants; Benzimidazoles; Blood Loss, Surgical; Cesarean Section; Contraindications; Dabigatran; Europe; Evidence-Based Medicine; Female; Fetus; Fondaparinux; Heparin; Heparin, Low-Molecular-Weight; Humans; Infant, Newborn; Morpholines; Polysaccharides; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Pyridines; Rivaroxaban; Societies, Medical; Thiophenes; Thrombophilia; United States; Uterine Hemorrhage; Venous Thromboembolism; Warfarin