COMPARISON OF RIVAROXABAN AND ENOXAPARIN ON BLOOD LOSS AFTER TOTAL KNEE ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIJun ,  JINGJuehua , ZHOUYun , YAOYunfeng , ZHANJunfeng

Department of Orthopaedics, the Second Affiliated Hospital of Anhui Medical University, Hefei Anhui, 230601, P. R. China;

Corresponding author：

JINGJuehua, Email: jingjuehuapaper@163.com

Keywords：

Rivaroxaban; Enoxaparin; Total knee arthroplasty; Postoperative blood loss

DOI：

10.7507/1002-1892.20140006

Video：

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Objective To compare the effect on blood loss after total knee arthroplasty (TKA) between rivaroxaban and enoxaparin. Methods 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. Results 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) (χ₂=4.624, P=0.032). Conclusion 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.

Citation： LIJun, JINGJuehua, ZHOUYun, YAOYunfeng, ZHANJunfeng. COMPARISON OF RIVAROXABAN AND ENOXAPARIN ON BLOOD LOSS AFTER TOTAL KNEE ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(1): 26-29. doi: 10.7507/1002-1892.20140006 Copy

1.	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.
2.	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.
3.	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.
4.	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.
5.	李军,王健,李阳,等.利伐沙班对人工全膝关节置换术后出血风险的影响.中国修复重建外科杂志,2011,25(11):1323-1325.
6.	中华医学会骨科学分会.骨关节炎诊治指南(2007年版).中华骨科杂志,2007,27(10):793-796.
7.	Gross JB.Estimating allowable blood loss:corrected for dilution.Anesthesiology,1983,58(3):277-280.
8.	Nadler SB,Hidalgo JH,Bloch T.Prediction of blood volume in normal human adults.Surgery,1962,51(2):224-232.
9.	高福强,李子剑,张克,等.初次全膝关节置换术后隐性失血的影响因素研究.中华外科杂志,2011,49(5):419-423.
10.	Sehat KR,Evans R,Newman JH.How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account.Knee,2000,7(3):151-155.
11.	Geerts WH,Pineo GF,Heit JA,et al.Prevention of venous thromboembolism:the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.Chest,2004,126(3 Suppl):338S-400S.
12.	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(6 Suppl):381S-453S.
13.	Pattison E,Protheroe K,Pringle RM,et al.Reduction in haemoglobin after knee joint surgery.Ann Rheum Dis,1973,32(6):582-584.
14.	Erskine JG,Fraser C,Simpson R,et al.Blood loss with knee joint replacement.J R Coll Surg Edinb,1981,26(5):295-297.
15.	Rama KR,Apsingi S,Poovali S,et al.Timing of tourniquet release in knee arthroplasty.Meta-analysis of randomized,controlled trials.J Bone Joint Surg (Am),2007,89(4):699-705.
16.	Thorey F,Stukenborg-Colsman C,Windhagen H,et al.The effect of tourniquet release timing on perioperative blood loss in simultaneous bilateral cemented total knee arthroplasty:a prospective randomized study.Technol Health Care,2008,16(2):85-92.
17.	覃健,余存泰,徐中和,等.全髋关节及全膝关节置换术后隐性失血的临床影响.中华骨科杂志,2006,26(5):323-326.
18.	Shen HL,Li Z,Feng ML,et al.Analysis on hidden blood loss of total knee arthroplasty in treating knee osteoarthritis.Chin Med J (Engl),2011,124(11):1653-1656.
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.
20.	李军,周云,荆珏华,等.两种抗凝药物对人工全髋关节置换术隐性失血的影响比较.中国修复重建外科杂志,2013,27(4):432-435.

1. 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.
2. 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.
3. 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.
4. 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.
5. 李军,王健,李阳,等.利伐沙班对人工全膝关节置换术后出血风险的影响.中国修复重建外科杂志,2011,25(11):1323-1325.
6. 中华医学会骨科学分会.骨关节炎诊治指南(2007年版).中华骨科杂志,2007,27(10):793-796.
7. Gross JB.Estimating allowable blood loss:corrected for dilution.Anesthesiology,1983,58(3):277-280.
8. Nadler SB,Hidalgo JH,Bloch T.Prediction of blood volume in normal human adults.Surgery,1962,51(2):224-232.
9. 高福强,李子剑,张克,等.初次全膝关节置换术后隐性失血的影响因素研究.中华外科杂志,2011,49(5):419-423.
10. Sehat KR,Evans R,Newman JH.How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account.Knee,2000,7(3):151-155.
11. Geerts WH,Pineo GF,Heit JA,et al.Prevention of venous thromboembolism:the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.Chest,2004,126(3 Suppl):338S-400S.
12. 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(6 Suppl):381S-453S.
13. Pattison E,Protheroe K,Pringle RM,et al.Reduction in haemoglobin after knee joint surgery.Ann Rheum Dis,1973,32(6):582-584.
14. Erskine JG,Fraser C,Simpson R,et al.Blood loss with knee joint replacement.J R Coll Surg Edinb,1981,26(5):295-297.
15. Rama KR,Apsingi S,Poovali S,et al.Timing of tourniquet release in knee arthroplasty.Meta-analysis of randomized,controlled trials.J Bone Joint Surg (Am),2007,89(4):699-705.
16. Thorey F,Stukenborg-Colsman C,Windhagen H,et al.The effect of tourniquet release timing on perioperative blood loss in simultaneous bilateral cemented total knee arthroplasty:a prospective randomized study.Technol Health Care,2008,16(2):85-92.
17. 覃健,余存泰,徐中和,等.全髋关节及全膝关节置换术后隐性失血的临床影响.中华骨科杂志,2006,26(5):323-326.
18. Shen HL,Li Z,Feng ML,et al.Analysis on hidden blood loss of total knee arthroplasty in treating knee osteoarthritis.Chin Med J (Engl),2011,124(11):1653-1656.
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.
20. 李军,周云,荆珏华,等.两种抗凝药物对人工全髋关节置换术隐性失血的影响比较.中国修复重建外科杂志,2013,27(4):432-435.

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COMPARISON OF RIVAROXABAN AND ENOXAPARIN ON BLOOD LOSS AFTER TOTAL KNEE ARTHROPLASTY

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