SAFETY AND EFFICACY OF RIVAROXABAN FOR PREVENTION OF DEEP VEIN THROMBOSIS IN PATIENTS WITH PREOPERATIVE ABNORMAL D-DIMER AFTER TOTAL KNEE ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUNYunbo , WANGLei , SHENXingqin , ZHANGDongliang , LIUJun ,  SUNZhenhui

Department of Joint Surgery, People's Hospital of Tianjin, Tianjin, 300121, P. R. China;

Corresponding author：

SUNZhenhui, Email: sunzhenhui123@gmail.com

Keywords：

Total knee arthroplasty; D-dimer; Deep vein thrombosis; Rivaroxaban

DOI：

10.7507/1002-1892.20140210

Video：

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Objective 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). Methods 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. Results 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. Conclusion 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.

Citation： SUNYunbo, WANGLei, SHENXingqin, ZHANGDongliang, LIUJun, SUNZhenhui. SAFETY AND EFFICACY OF RIVAROXABAN FOR PREVENTION OF DEEP VEIN THROMBOSIS IN PATIENTS WITH PREOPERATIVE ABNORMAL D-DIMER AFTER TOTAL KNEE ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(8): 955-959. doi: 10.7507/1002-1892.20140210 Copy

1.	Kim KI,Cho KY,Jin W,et al.Recent Korean perspective of deep vein thrombosis after total knee arthroplasty.J Arthroplasty,2011,26(7):1112-1116.
2.	Wu PK,Chen CF,Chung LH,et al.Pulmonary embolism following total knee arthroplasty in Taiwanese patients.J Chin Med Assoc,2013,77(3):155-159.
3.	Yeager AM,Ruel AV,Westrich GH.Are bilateral total joint arthroplasty patients at a higher risk of developing pulmonary embolism following total hip and knee surgery? J Arthroplasty,2014,29(5):900-902..
4.	Jacobs JJ,Mont MA,Bozic KJ,et al.American Academy of Orthopaedic Surgeons clinical practice guideline on:preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty.J Bone Joint Surg (Am),2012,94(8):746-747.
5.	Thomas TF,Ganetsky V,Spinler SA.Rivaroxaban:an oral factor Xa inhibitor.Clin Ther,2013,35(1):4-27.
6.	Russell RD,Huo MH.Apixaban and rivaroxaban decrease deep venous thrombosis but not other complications after total hip and total knee arthroplasty.J Arthroplasty,2013,28(9):1477-1481.
7.	Russell RD,Hotchkiss WR,Knight JR,et al.The efficacy and safety of rivaroxaban for venous thromboembolism prophylaxis after total hip and total knee arthroplasty.Thrombosis,2013.doi:10.1155/2013/762310.
8.	Niimi R,Hasegawa M,Shi DQ,et al.The influence of fondaparinux on the diagnosis of postoperative deep vein thrombosis by soluble fibrin and D-dimer.Thromb Res,2012,130(5):759-764.
9.	Tsuji S,Kobayashi A,Tomita T,et al.Quantitative index for deciding whether to administer preventive anticoagulant therapy in osteoarthritis patients undergoing total knee arthroplasty.J Orthop Sci,2013.[Epub ahead of print].
10.	孙振辉,刘军,田峥巍,等.间隙平衡技术在全膝关节置换术中应用的中期随访研究.中国矫形外科杂志,2013,21(13):1292-1296.
11.	Chotanaphuthi T,Heebthamai D,Taweewuthisub W,et al.Prediction of deep vein thrombosis after total knee arthroplasty with preoperative D-dimer plasma measurement.J Med Assoc Thai,2009,92 Suppl 6:S6-10.
12.	Shimoyama Y,Sawai T,Tatsumi S,et al.Perioperative risk factors for deep vein thrombosis after total hip arthroplasty or total knee arthroplasty.J Clin Anesth,2012,24(7):531-536.
13.	Bounameaux H,Miron MJ,Blanchard J,et al.Measurement of plasma D-dimer is not useful in the prediction or diagnosis of postoperative deep vein thrombosis in patients undergoing total knee arthroplasty.Blood Coagul Fibrinolysis,1998,9(8):749-752.
14.	Watanabe H,Madoiwa S,Sekiya H,et al.Predictive blood coagulation markers for early diagnosis of venous thromboembolism after total knee joint replacement.Thromb Res,2011,128(6):e137-143.
15.	Rafee A,Herlikar D,Gilbert R,et al.D-Dimer in the diagnosis of deep vein thrombosis following total hip and knee replacement:a prospective study.Ann R Coll Surg Engl,2008,90(2):123-126.
16.	Rath NK,Goodson MW,White SP,et al.The use of rivaroxaban for chemical thromboprophylaxis following total knee replacement.Knee,2013,20(6):397-400.
17.	李军,荆珏华,周云,等.利伐沙班和依诺肝素钠对人工全膝关节置换术后失血风险的影响比较.中国修复重建外科杂志,2014,28(1):26-29.

1. Kim KI,Cho KY,Jin W,et al.Recent Korean perspective of deep vein thrombosis after total knee arthroplasty.J Arthroplasty,2011,26(7):1112-1116.
2. Wu PK,Chen CF,Chung LH,et al.Pulmonary embolism following total knee arthroplasty in Taiwanese patients.J Chin Med Assoc,2013,77(3):155-159.
3. Yeager AM,Ruel AV,Westrich GH.Are bilateral total joint arthroplasty patients at a higher risk of developing pulmonary embolism following total hip and knee surgery? J Arthroplasty,2014,29(5):900-902..
4. Jacobs JJ,Mont MA,Bozic KJ,et al.American Academy of Orthopaedic Surgeons clinical practice guideline on:preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty.J Bone Joint Surg (Am),2012,94(8):746-747.
5. Thomas TF,Ganetsky V,Spinler SA.Rivaroxaban:an oral factor Xa inhibitor.Clin Ther,2013,35(1):4-27.
6. Russell RD,Huo MH.Apixaban and rivaroxaban decrease deep venous thrombosis but not other complications after total hip and total knee arthroplasty.J Arthroplasty,2013,28(9):1477-1481.
7. Russell RD,Hotchkiss WR,Knight JR,et al.The efficacy and safety of rivaroxaban for venous thromboembolism prophylaxis after total hip and total knee arthroplasty.Thrombosis,2013.doi:10.1155/2013/762310.
8. Niimi R,Hasegawa M,Shi DQ,et al.The influence of fondaparinux on the diagnosis of postoperative deep vein thrombosis by soluble fibrin and D-dimer.Thromb Res,2012,130(5):759-764.
9. Tsuji S,Kobayashi A,Tomita T,et al.Quantitative index for deciding whether to administer preventive anticoagulant therapy in osteoarthritis patients undergoing total knee arthroplasty.J Orthop Sci,2013.[Epub ahead of print].
10. 孙振辉,刘军,田峥巍,等.间隙平衡技术在全膝关节置换术中应用的中期随访研究.中国矫形外科杂志,2013,21(13):1292-1296.
11. Chotanaphuthi T,Heebthamai D,Taweewuthisub W,et al.Prediction of deep vein thrombosis after total knee arthroplasty with preoperative D-dimer plasma measurement.J Med Assoc Thai,2009,92 Suppl 6:S6-10.
12. Shimoyama Y,Sawai T,Tatsumi S,et al.Perioperative risk factors for deep vein thrombosis after total hip arthroplasty or total knee arthroplasty.J Clin Anesth,2012,24(7):531-536.
13. Bounameaux H,Miron MJ,Blanchard J,et al.Measurement of plasma D-dimer is not useful in the prediction or diagnosis of postoperative deep vein thrombosis in patients undergoing total knee arthroplasty.Blood Coagul Fibrinolysis,1998,9(8):749-752.
14. Watanabe H,Madoiwa S,Sekiya H,et al.Predictive blood coagulation markers for early diagnosis of venous thromboembolism after total knee joint replacement.Thromb Res,2011,128(6):e137-143.
15. Rafee A,Herlikar D,Gilbert R,et al.D-Dimer in the diagnosis of deep vein thrombosis following total hip and knee replacement:a prospective study.Ann R Coll Surg Engl,2008,90(2):123-126.
16. Rath NK,Goodson MW,White SP,et al.The use of rivaroxaban for chemical thromboprophylaxis following total knee replacement.Knee,2013,20(6):397-400.
17. 李军,荆珏华,周云,等.利伐沙班和依诺肝素钠对人工全膝关节置换术后失血风险的影响比较.中国修复重建外科杂志,2014,28(1):26-29.

Chinese Journal of Reparative and Reconstructive Surgery

SAFETY AND EFFICACY OF RIVAROXABAN FOR PREVENTION OF DEEP VEIN THROMBOSIS IN PATIENTS WITH PREOPERATIVE ABNORMAL D-DIMER AFTER TOTAL KNEE ARTHROPLASTY

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