Rivaroxaban and low molecular heparin in prevention of deep venous thrombosis and blood loss after total hip arthroplasty in elderly patients

doi:10.3969/j.issn.2095-4344.0189

Abstract

Abstract:

BACKGROUND: Deep venous thrombosis and blood loss are common complications after total hip arthroplasty in elderly patients. Thus, it needs to pick valid treatments to reduce the harm in the clinical treatment.

OBJECTIVE: To compare and observe the effects of rivaroxaban and low molecular heparin on preventing deep venous thrombosis and blood loss after total hip arthroplasty in elderly patients.

METHODS: 196 cases in Department of Orthopedics, General Hospital of Shuicheng Mining Group of Guizhou Province treated by unilateral total hip arthroplasty were enrolled between January 2015 and January 2017. They were randomly divided into observation group (98 cases) and control group (98 cases). The observation group was treated with oral rivaroxaban 6 hours after surgery for 2 consecutive weeks. The control group was subcutaneously injected with low molecular heparin injection 6 hours after surgery for 5 consecutive weeks. The coagulation index was measured by automatic coagulation analyzer at preoperative, 1 day, 1 and 2 weeks after surgery. Deep venous thrombosis was evaluated in the two groups. The caliber sizes of superficial femoral vein and popliteal vein were measured by color Doppler ultrasound before surgery, 1, 2, 3 and 4 weeks after surgery. Blood loss was recorded in the two groups.

RESULTS AND CONCLUSION: (1) The difference in serum D-dimer levels was statistically significant 1 and 2 weeks after surgery in both groups (P < 0.05). Serum D-dimer levels were lower in the observation group than in the control group. (2) The incidence of deep venous thrombosis was lower in the observation group than in the control group (P < 0.05). (3) The caliber size of superficial femoral vein and popliteal vein was significantly different 1, 2, 3 and 4 weeks after surgery in both groups (P < 0.05). The caliber size of superficial femoral vein and popliteal vein was larger in the observation group than in the control group. (4) Hidden blood loss and total blood loss were significantly different between the two groups (P < 0.05). The hidden blood loss and total blood loss were higher in the observation group than in the control group. (5) Results suggest that rivaroxaban has a positive meaning for prevention of deep venous thrombosis after total hip arthroplasty in elderly patients. However, hidden blood loss is worthy of attention.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Heparin, Venous Thrombosis, Arthroplasty, Replacement, Hip, Blood Loss, Surgical, Tissue Engineering

CLC Number:

R318

Bai Yun-fei, Fang Ti-gang, Sun Rui. Rivaroxaban and low molecular heparin in prevention of deep venous thrombosis and blood loss after total hip arthroplasty in elderly patients[J]. Chinese Journal of Tissue Engineering Research, 2018, 22(15): 2303-2308.

Figures/Tables 3

References

[1] 李靖扬,刘振峰,乔为民,等. 骨水泥型假体和生物型假体中年全髋关节置换:5年随访比较[J]. 中国组织工程研究, 2015,19(26): 4107-4111.

[2] Mclaughlin JR, Lee KR. Total hip arthroplasty with an uncemented tapered femoral component in patients younger than 50 years of age: a minimum 20-year follow-up study. J Bone Joint Surg Br. 2016;31(6):1275-1278.

[3] Eschweiler J, Hawlitzky J, Quack V, et al. Biomechanical model based evaluation of Total Hip Arthroplasty therapy outcome. J Orthop. 2017;14(4):582-588.

[4] Connolly KP, Kamath AF. Direct anterior total hip arthroplasty: Literature review of variations in surgical technique. World J Orthop. 2016; 7(1):38-43.

[5] Dua A, Desai SS, Lee CJ, et al. National trends in deep vein thrombosis following total knee and total hip replacement in the USA. Ann Vasc Surg. 2017;38:310-314.

[6] Kim JW, Oh CW, Oh JK, et al. The incidence and the risk factors of venous thromboembolism in Korean patients with pelvic or acetabular fractures. J Orthop Sci. 2014;19(3): 471-477.

[7] 俞斌,季英,禹宝庆. 下肢深静脉血栓的诊断及治疗进展[J]. 中国骨与关节损伤杂志, 2017, 32(1):109-111.

[8] 陆嫣. 骨科下肢手术后深静脉血栓的预防及护理进展[J]. 循证护理, 2017, 3(1):41-43.

[9] 中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南(第2版)[J]. 中华外科杂志,2012,50(7):611-614.

[10] 中华医学会骨科学分会. 中国骨科大手术静脉血栓栓塞症预防指南[J]. 中华骨科杂志,2016,36(2):65-71.

[11] Petitou M. A synthetic pentasaccharide for the prevention of deep-vein thrombosis after total hip replacement-NEJM. New Eng J Med. 2001;344(9):619-625.

[12] Malyszko J. Mechanism of endothelial dysfunction in chronic kidney disease. Clin Chimica Acta. 2010;411(19): 1412-1420.

[13] Wakabayashi H, Hasegawa M, Rui N, et al. Clinical analysis of preoperative deep vein thrombosis risk factors in patients undergoing total hip arthroplasty. Thromb Res. 2015;136(5): 855-858.

[14] Yanrong Z, Wenjing L, Tianwei Y, et al. Early detection of lesions of dorsal artery of foot in patients with type 2 diabetes mellitus by high-frequency ultrasonography. 2009;29(3): 387-390.

[15] 闫建红,李保. 肝素诱导血小板减少症的新进展[J]. 临床医药实践, 2016, 253(2):128-132.

[16] 乌兰,党永康,杨柳. 下肢深静脉血栓抗凝药物研究进展[J]. 血管与腔内血管外科杂志, 2017,3(3):795-799.

[17] Ufer M. Comparative efficacy and safety of the novel oral anticoagulants dabigatran, rivaroxaban and apixaban in preclinical and clinical development. Thromb Haemost. 2010; 103(3):572-585.

[18] Laube ES, Mantha S, Samedy P, et al. Treatment of central venous catheter-associated deep venous thrombosis in cancer patients with rivaroxaban. Am J Hematol. 2017;92(1): E9.

[19] Weitz JI, Awa L, Prins MH, et al. Rivaroxaban or aspirin for extended treatment of venous thromboembolism. New Eng J Med. 2017;376(13):1211-1222.

[20] Hom L, Sobieraj DM. The impact of initiating rivaroxaban versus low-molecular weight heparin plus warfarin in patients admitted to the hospital for venous thromboembolism. Int J Cardiol. 2015;198:87-88.

[21] Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315-352.

[22] 赵凡,李成程. 抗凝新药利伐沙班临床研究[J]. 医学信息, 2016, 29(23):231.

[23] Kwong LM. Comparative safety and efficacy of antithrombotics in the management of venous thromboembolism after knee or hip replacement surgery: focus on rivaroxaban. Clin Pharmacol Adv Appl. 2013;5(1): 143-148.

[24] Ayata M, Kaptan Z, Uzunkulao?lu H, et al. Effect of enoxaparin sodium on experimentally-induced myringosclerosis in rats. J Int Adv Otol. 2015;11(3):192-195.

[25] Goto M, Yoshizato T, Tatsumura M, et al. Safety and efficacy of thromboprophylaxis using enoxaparin sodium after cesarean section: A multi-center study in Japan. Taiwan J Obstet Gynecol. 2015;54(3):248-252.

[26] 董文涛,周永芳. 利伐沙班治疗老年髋部骨折术后下肢深静脉血栓的效果观察[J]. 海峡药学, 2017, 29(1):125-126.

[27] Kucher N, Aujesky D, Beer JH, et al. Rivaroxaban for the treatment of venous thromboembolism. The SWIss Venous Thromboembolism Registry (SWIVTER). Thromb Haemost. 2016;116(3):472-479.

[28] Margolis JM, Deitelzweig S, Kline J, et al. Shorter hospital stays and lower costs for rivaroxaban compared with warfarin for venous thrombosis admissions. J Am Heart Assoc. 2016; 5(10):3788.

[29] 李东阳,陈兴国,王勇,等. 凝血功能指标与创伤性骨折患者术后深静脉血栓形成的关系[J]. 中国实验诊断学, 2017, 21(5): 789-792.

[30] 孙少君, 王晓明. Wells评分联合D-二聚体预测下肢深静脉血栓的价值[J]. 实用医学杂志, 2016, 32(1):98-101.

[31] 李世飞,祝孟海,姚琦. D-二聚体及纤维蛋白原对老年髋部骨折患者围术期深静脉血栓形成的诊断价值[J]. 北京医学,2017,39(2): 143-145.

[32] 余华,何凤. 彩色多普勒超声检查对早期发现下肢静脉血栓形成的临床意义[J]. 临床医学研究与实践,2017,2(22):137-138.

[33] 邵素臣,俞昌明. 彩色多普勒超声在下肢深静脉血栓诊断中的临床应用[J]. 医学影像学杂志, 2017,27(4):783-786.

[34] Rosencher N, Kerkkamp HE, Macheras G, et al. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) study: blood management in elective knee and hip arthroplasty in Europe. Transfusion. 2003;43(4):459-469.

[35] 侯振扬,孙义玲,庞涛,等. 氨甲环酸两种不同用药方式对全髋关节置换围手术期失血量的影响:前瞻性、开放性、随机对照临床试验[J]. 中国组织工程研究,2017,21(15):2314-2319.

[36] Ohmori T, Kitamura T, Onishi H, et al. Effect of pre-injury anticoagulant and antiplatelet agents on blood loss in elderly patients with severe trauma. Acute Med Surg. 2016;3(2): 114-119.

[37] George J, Sikora M, Masch J, et al. Infection is not a risk factor for perioperative and postoperative blood loss and transfusion in revision total hip arthroplasty. J Arthroplasty. 2017;32(1):214-219.

[38] 侯炜,葛京化,张霆,等. 135例半髋关节置换患者的隐性失血分析[J]. 中国中医骨伤科杂志, 2017,25(7):44-46.

[39] Gao F, Sun W, Guo W, et al. Topical administration of tranexamic acid plus diluted-epinephrine in primary total knee arthroplasty: a randomized double-blinded controlled trial. J Arthroplasty. 2015;30(8):1354-1358.

[40] Pedersen AB, Sorensen HT, Mehnert F, et al. Effectiveness and safety of different duration of thromboprophylaxis in 16,865 hip replacement patients - A real-word, prospective observational study. Thromb Res. 2015;135(2):322-328.