COMPARISON OF EFFECTS OF TWO ANTICOAGULANTS ON HIDDEN BLOOD LOSS AFTER TOTAL HIP ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Jun , ZHOU Yun , JING Juehua , ZHAN Junfeng.

Department of Orthopaedics, the Second Hospital, Anhui Medical University, Hefei Anhui, 230601, P.R.China. Corresponding author: JING Juehua, E-mail: jjhhu@sina.com;

Corresponding author：

Keywords：

Rivaroxaban; Enoxaparin; Total hip arthroplasty; Hidden blood loss; Bleeding event

DOI：

10.7507/1002-1892.20130100

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Objective To compare the effects of rivaroxaban and enoxaparin on hidden blood loss after total hip arthroplasty (THA). Methods 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 gt; 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. Results 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 gt; 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 (χ2=1.073, P=0.390). Conclusion 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.

Citation： LI Jun,ZHOU Yun,JING Juehua,ZHAN Junfeng.. COMPARISON OF EFFECTS OF TWO ANTICOAGULANTS ON HIDDEN BLOOD LOSS AFTER TOTAL HIP ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(4): 432-435. doi: 10.7507/1002-1892.20130100 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.	Huisman MV, Quinlan DJ, Dahl OE, et al. Enoxaparin versus dabigatran or rivaroxaban for thromboprophylaxis after hip or knee arthroplasty: Results of separate pooled analyses of phase III multicenter randomized trials. Circ Cardiovasc Qual Outcomes, 2010, 3(6): 652-660.
4.	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.
5.	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.
6.	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.
7.	张鹤山, 李子荣. 股骨头坏死诊断与治疗的专家建议. 中华骨科杂志, 2007, 27(2): 146-148.
8.	Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
9.	Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
10.	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.
11.	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.
12.	Pattison E, Protheroe K, Pringle RM, et al. Reduction in haemoglobin after knee joint surgery. Ann Rheum Dis, 1973, 32(6): 582-584.
13.	Erskine JG, Fraser C, Simpson R, et al. Blood loss with knee joint replacement. J R Coll Surg Edinb, 1981, 26(5): 295-297.
14.	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.
15.	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.
16.	丛宇, 赵建宁, 包倪荣, 等. 隐性失血对全髋关节置换术后功能恢复影响的临床观察. 中国骨伤, 2011, 24(6): 466-468.
17.	高玉镭, 王东辰, 李佩佳, 等. 人工全髋关节置换术隐性失血量的估算及原因分析. 实用医药杂志, 2012, 29(6): 490-492.
18.	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.
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.

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. Huisman MV, Quinlan DJ, Dahl OE, et al. Enoxaparin versus dabigatran or rivaroxaban for thromboprophylaxis after hip or knee arthroplasty: Results of separate pooled analyses of phase III multicenter randomized trials. Circ Cardiovasc Qual Outcomes, 2010, 3(6): 652-660.
4. 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.
5. 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.
6. 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.
7. 张鹤山, 李子荣. 股骨头坏死诊断与治疗的专家建议. 中华骨科杂志, 2007, 27(2): 146-148.
8. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
9. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
10. 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.
11. 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.
12. Pattison E, Protheroe K, Pringle RM, et al. Reduction in haemoglobin after knee joint surgery. Ann Rheum Dis, 1973, 32(6): 582-584.
13. Erskine JG, Fraser C, Simpson R, et al. Blood loss with knee joint replacement. J R Coll Surg Edinb, 1981, 26(5): 295-297.
14. 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.
15. 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.
16. 丛宇, 赵建宁, 包倪荣, 等. 隐性失血对全髋关节置换术后功能恢复影响的临床观察. 中国骨伤, 2011, 24(6): 466-468.
17. 高玉镭, 王东辰, 李佩佳, 等. 人工全髋关节置换术隐性失血量的估算及原因分析. 实用医药杂志, 2012, 29(6): 490-492.
18. 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.
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.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARISON OF EFFECTS OF TWO ANTICOAGULANTS ON HIDDEN BLOOD LOSS AFTER TOTAL HIP ARTHROPLASTY

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