Anticoagulant effect of low-molecular-weight heparin versus rivaroxaban after arthroplasty assessed by thromboelastography

doi:10.3969/j.issn.2095-4344.1029

Abstract

Abstract:

BACKGROUND: Low-molecular-weight heparin and rivaroxaban are commonly used anticoagulant drugs after hip and knee arthroplasties. Low-molecular-weight heparin may cause decrease in platelets, and rivaroxaban has been shown to make no effect on platelets. Both of them have been shown to decrease the incidence of deep venous thrombosis, while these choices in clinic still remain controversial.

OBJECTIVE: To evaluate the coagulation function of patients undergoing hip or knee arthroplasty after anticoagulation using low-molecular-weight heparin or rivaroxaban by thromboelastograph, and to analyze the differences in anticoagulant effect and platelet count between two drugs.

METHODS: A prospective study was conducted, including 397 patients undergoing unilateral knee or hip arthroplasty at the Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University from 2014 to 2017. The patients were randomly divided into two groups, 195 patients in the low-molecular-weight heparin group received subcutaneous injection of low molecular weight heparin (4 000 IU) at 12 hours postoperatively. 202 patients in the rivaroxaban group received 10 mg of rivaroxaban orally at 12 hours postoperatively. Thromboelastograph and platelet count were performed at baseline, 1, 3, 5 and 7 days postoperatively. The differences of proportion of hypercoagulability and platelet count were compared between two groups at different time points, and the reason was analyzed.

RESULTS AND CONCLUSION: (1) In the low-molecular-weight heparin group, the proportion of patients with hypercoagulability increased gradually from 1 to 7 days after surgery, which reached to 93.1% on day 7. In the rivaroxaban group, the proportion of patients with hypercoagulability on day 3 was lower than that on day 1 after surgery, and the proportion of hypercoagulability increased gradually during the 3-7 days, which reached to 75.3% on day 7. There was significant difference in the proportion of hypercoagulability between two groups (P < 0.05). (2) The average platelet count in both groups decreased slightly than that at baseline. However, the average platelet count increased during 3-7 days after surgery, and the count on day 7 was significantly higher than the baseline level. The average platelet count in the rivaroxaban group was significantly higher than that in the low-molecular-weight heparin group (P < 0.05). (3) Thromboelastograph results indicate that the anticoagulant effect of rivaroxaban is better than that of low-molecular-weight heparin after hip and knee arthroplasties, and the latter may inhibit the reactivity of platelet counts after surgery.

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: Platelet Count, Arthroplasty, Replacement, Heparin, Low-Molecular-Weight, Tissue Engineering

CLC Number:

R459.9

Jian Changchun, Chen Yu, Chen Cheng, Hu Ning, Huang Wei. Anticoagulant effect of low-molecular-weight heparin versus rivaroxaban after arthroplasty assessed by thromboelastography [J]. Chinese Journal of Tissue Engineering Research, 2019, 23(4): 499-504.

Figures/Tables 4

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