rivaroxaban and Osteoarthritis--Knee

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

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

To evaluate the safety and efficacy of rivaroxaban for prevention of deep vein thrombosis (DVT) in patients with preoperative abnormal D-dimer after total knee arthroplasty (TKA).. Between August and September 2013, 60 consecutive patients with varus knee osteoarthritis undergoing unilateral TKA were enrolled in the study. According to the preoperative D-dimer level, the patients were divided into 2 groups: D-dimer normal group (control group, n = 41) and D-dimer abnormal group (test group, n = 19). No significant difference was found in gender, age, body mass index, and preoperative knee range of motion between 2 groups (P > 0.05). All patients underwent conventional primary TKA and anticoagulation therapy with rivaroxaban to prevent DVT. The tourniquet use time, postoperative hospitalization time, and total hospitalization time were compared between 2 groups. At 1, 3, and 5 days after operation, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (FIB), and D-dimer were measured. Wound complications and DVT were observed.. The postoperative hospitalization time of the test group was significantly longer than that of the control group (t = 2.327, P = 0.031), while the tourniquet use time and total hospitalization time showed no significant difference between 2 groups (P > 0.05). All the patients were followed up 6-8 months (mean, 7.2 months). Wound complications occurred in 3 cases (7.3%) of the control group and in 2 cases (10.5%) of the test group, showing no significant difference (χ2 = 0.175, P = 0.676). Color ultrasonography showed no pulmonary embolism and DVT at 6 weeks after TKA. There were significant differences in PT, TT, and FIB between at pre- and post-TKA in the same group, but no significant difference was found between 2 groups. The APTT and D-dimer had significant differences between at pre- and post-TKA in the same group, and between groups. There was no significant interaction effect between time and group for each index.. Preoperative abnormal D-dimer level should not be regarded as a contraindication for TKA. The risks of DVT and wound complications in patients with abnormal D-dimer level are similar to patients with normal D-dimer level using rivaroxaban administration after TKA. It is unnecessary to conventional monitor D-dimer and other coagulation and hemorrhage laboratory tests in the patients after TKA.

Topics: Antifibrinolytic Agents; Arthroplasty, Replacement, Knee; Factor Xa Inhibitors; Fibrin Fibrinogen Degradation Products; Humans; Knee Joint; Length of Stay; Morpholines; Osteoarthritis, Knee; Postoperative Complications; Postoperative Period; Preoperative Care; Prothrombin Time; Range of Motion, Articular; Rivaroxaban; Safety; Thiophenes; Venous Thrombosis

Rivaroxaban is the first licensed oral direct inhibitor of factor Xa. Recent studies from the RECORD trials suggest rivaroxaban has superior efficacy compared to enoxaparin in preventing venous thromboembolism (VTE) with no significant increase in the major bleeding risk. Concerns remain regarding the incidence of minor bleeding, consequent delayed wound healing and subsequent risk of infection. The aim of this observational study was to assess the incidence of post-operative complications in patients receiving either rivaroxaban or enoxaparin thromboprophylaxis following elective hip and knee arthroplasty.. A total of 258 patients undergoing elective total hip or knee arthroplasty within one NHS Trust were included. A total of 202 subjects (mean age, 70.7 years ± 10.0, 43 % men) received a daily dose of 10 mg of oral rivaroxaban and 56 (mean age, 70.9 years ± 9.8, 39 % men) had a daily subcutaneous injection of 40 mg of enoxaparin as thromboprophylaxis. Endpoints included VTE (deep vein thrombosis and pulmonary embolism), haemorrhagic wound complications, hospital re-admission, requirement for blood transfusion, minor and major bleeding and death.. There were no significant differences in the incidence of VTE, requirement for blood transfusion and readmission rate between rivaroxaban and enoxaparin-treated patients. The incidence of minor bleeding (2.0 vs. 0 %) and haemorrhagic wound complications (5.0 vs. 1.8 %) were non-significantly higher in the rivaroxaban-treated group. There were no cases of pulmonary embolism, major bleeding or death in either group.. Our experience with rivaroxaban in elective hip and knee arthroplasty showed no significant difference in the incidence of VTE or major bleeding. There was, however, a tendency to greater risk of minor bleeding and wound complications that were largely haemorrhagic in nature, which may have reached significance in a larger study.

Topics: Aged; Anticoagulants; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Chemoprevention; Elective Surgical Procedures; Enoxaparin; Female; Hemorrhage; Humans; Male; Middle Aged; Morpholines; Osteoarthritis, Hip; Osteoarthritis, Knee; Outcome and Process Assessment, Health Care; Postoperative Complications; Rivaroxaban; Thiophenes; United Kingdom; Venous Thromboembolism; Wound Healing

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.. 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 > 0.05).. 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 (chi2=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.. 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.

Topics: Aged; Aged, 80 and over; Anticoagulants; Arthroplasty, Replacement, Knee; Blood Transfusion; Female; Hemoglobins; Heparin, Low-Molecular-Weight; Humans; Male; Middle Aged; Morpholines; Osteoarthritis, Knee; Postoperative Complications; Postoperative Hemorrhage; Range of Motion, Articular; Retrospective Studies; Rivaroxaban; Thiophenes; Treatment Outcome; Venous Thrombosis