Comparison of hemostatic effect and safety in primary unilateral total hip arthroplasty receiving different anticoagulants after anti-fibrinolysis with tranexamic acid_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DENG Zengfa , SHENG Puyi , XU Dongliang , FU Ming , HE Aishan , LIAO Weiming ,  KANG Yan

Department of Joint Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou Guangdong, 510080, P.R.China;

Corresponding author：

KANG Yan, Email: neokang@163.com

Keywords：

Tranexamic acid; nadroparin calcium; enoxaparin sodium; rivaroxaban; apixaban; total hip arthroplasty

DOI：

10.7507/1002-1892.202006007

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Objective To compare the hemostatic effect and safety in primary unilateral total hip arthroplasty (THA) receiving nadroparin calcium, enoxaparin sodium, rivaroxaban, or apixaban after anti-fibrinolysis with tranexamic acid (TXA) and explore the best anticoagulant.Methods A retrospective analysis was conducted on 184 patients who underwent the primary unilateral THA between January 2014 and December 2018, administrated 15 mg/kg TXA before surgery and received nadroparin calcium, enoxaparin sodium, rivaroxaban, or apixaban. The patients were divided into four groups based on the different anticoagulants: 46 patients received nadroparin calcium; 45 patients received enoxaparin sodium; 47 patients received rivaroxaban; the other 46 patients received apixaban. There was no significant difference in age, gender, body mass, body mass index, the types of hip joint diseases, complications, anesthesia mode, operation time, and preoperative laboratory indexes (hemoglobin, hematocrit, platelet, prothrombin time, activated partial prothrombin time, blood volume) (P>0.05). Perioperative blood data (total blood loss, hidden blood loss, dominant blood loss, postoperative drainage volume, maximum loss of hemoglobin, and blood transfusion rate) and complications (incision, bleeding, and thrombosis) were recorded and compared between groups.Results There was no significant difference in total blood loss, hidden blood loss, dominant blood loss, postoperative drainage volume, maximum loss of hemoglobin, and blood transfusion rate between groups (P>0.05). The comparison of postoperative complications showed that 1 case (2.1%) of redness and swelling of incision occurred in the rivaroxaban group, and 1 case (2.2%) of the other 3 groups each had poor incision healing. No incision infection, fat liquefaction, or other incision complications occurred in the 4 groups. There was no significant difference in incision complication between groups (P>0.05). There were 2 cases (4.3%) bleeding events (1 case of right inguinal hematoma and 1 case of subcutaneous ecchymosis in front of left leg) in the nadroparin calcium group, while no bleeding event occurred in the other 3 groups, which had no significant difference in bleeding complication between groups (χ²=5.612, P=0.132). There was 1 case (2.2%) of intermuscular vein thrombosis of the lower extremity in the nadroparin calcium group and no case in the other 3 groups, which had no significant difference between groups (χ²=2.789, P=0.425). Neither deep venous thrombosis nor pulmonary embolism occurred in any group.Conclusion No significant difference in the hemostatic effect and incidences of complications for patients underwent primary unilateral THA receiving nadroparin calcium, enoxaparin sodium, rivaroxaban, or apixaban after anti-fibrinolysis with TXA. One of the four anticoagulants can be selected to prevent thrombosis after anti-fibrinolysis with TXA, which has certain safety.

Citation： DENG Zengfa, SHENG Puyi, XU Dongliang, FU Ming, HE Aishan, LIAO Weiming, KANG Yan. Comparison of hemostatic effect and safety in primary unilateral total hip arthroplasty receiving different anticoagulants after anti-fibrinolysis with tranexamic acid. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(12): 1561-1567. doi: 10.7507/1002-1892.202006007 Copy

1.	Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet, 2007, 370(9597): 1508-1519.
2.	Lindman IS, Carlsson LV. Extremely low transfusion rates: Contemporary primary total hip and knee arthroplasties. J Arthroplasty, 2018, 33(1): 51-54.
3.	Song K, Pan P, Yao Y, et al. The incidence and risk factors for allogenic blood transfusion in total knee and hip arthroplasty. J Orthop Surg Res, 2019, 14(1): 273.
4.	Xu H, Zhang S, Xie J, et al. A nested case-control study on the risk factors of deep vein thrombosis for Chinese after total joint arthroplasty. J Orthop Surg Res, 2019, 14(1): 188.
5.	Zhang C, Xu B, Liang G, et al. Rivaroxaban versus nadroparin for preventing deep venous thrombosis after total hip arthroplasty following femoral neck fractures: A retrospective comparative study. J Int Med Res, 2018, 46(5): 1936-1946.
6.	Kinov P, Tanchev PP, Ellis M, et al. Antithrombotic prophylaxis in major orthopaedic surgery: an historical overview and update of current recommendations. Int Orthop, 2014, 38(1): 169-175.
7.	Stoicea N, Moran K, Mahmoud AR, et al. Tranexamic acid use during total hip arthroplasty: A single center retrospective analysis. Medicine (Baltimore), 2018, 97(21): e10720.
8.	谢锦伟, 岳辰, 裴福兴, 等. 氨甲环酸对类风湿关节炎患者全髋关节置换围手术期失血的影响. 中华骨科杂志, 2015, 35(8): 808-812.
9.	Ker K, Edwards P, Perel P, et al. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ, 2012, 344: e3054.
10.	张少云, 谢锦伟, 黄强, 等. 全膝关节置换术后多次静脉应用氨甲环酸对纤溶活性及炎症反应的影响. 中华骨科杂志, 2017, 37(23): 1483-1489.
11.	姚汝瞻, 王炳武, 潘洪发, 等. 创伤骨折手术应用氨甲环酸疗效和安全性的Meta分析. 中国循证医学杂志, 2019, 19(3): 331-337.
12.	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. 中华骨科杂志, 2016, 36(2): 65-71.
13.	Yu Z, Shan P, Yang X, et al. Comparison of efficiency and safety of rivaroxaban, apixaban and enoxaparin for thromboprophylaxis after arthroplastic surgery: a meta-analysis. Biosci Rep, 2018, 38(6): BSR20180423.
14.	孙伟, 史冬泉, 庞勇, 等. 全髋关节置换术后速碧林或拜瑞妥抗凝治疗对隐性失血量的影响. 中国骨与关节损伤杂志, 2013, 28(2): 136-137.
15.	范亚楠, 温阳阳, 李文龙, 等. 氨甲环酸抗纤溶后利伐沙班应用于全髋关节置换术的研究. 中国医药导报, 2017, 14(36): 84-88.
16.	Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
17.	Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
18.	Xie J, Hu Q, Ma J, et al. Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss and the inflammatory response following enhanced-recovery primary total hip arthroplasty: a randomised clinical trial. Bone Joint J, 2017, 99-B(11): 1442-1449.
19.	Lei Y, Huang Q, Huang Z, et al. Multiple-dose intravenous tranexamic acid further reduces hidden blood loss after total hip arthroplasty: A randomized controlled trial. J Arthroplasty, 2018, 33(9): 2940-2945.
20.	Morrison RJM, Tsang B, Fishley W, et al. Dose optimisation of intravenous tranexamic acid for elective hip and knee arthroplasty: The effectiveness of a single pre-operative dose. Bone Joint Res, 2017, 6(8): 499-505.
21.	岑光荣, 黄培祥, 陈志冲, 等. 抗凝药物对全髋关节置换术后隐形失血的影响. 中医正骨, 2013, 25(11): 23-25.
22.	Chambers S, Tidwell L, Kerkhof A, et al. Topical tranexamic acid is effective in cementless total knee arthroplasty. Orthop Clin North Am, 2020, 51(1): 7-11.
23.	Sukeik M, Alshryda S, Powell J, et al. The effect of tranexamic acid on wound complications in primary total hip arthroplasty: A meta-analysis. Surgeon, 2020, 18(1): 53-61.
24.	Ricket AL, Stewart DW, Wood RC, et al. Comparison of postoperative bleeding in total hip and knee arthroplasty patients receiving rivaroxaban or enoxaparin. Ann Pharmacother, 2016, 50(4): 270-275.
25.	Kumar PD. Prevention and treatment of major blood loss. N Engl J Med, 2007, 357(12): 1260-1261.
26.	谢锦伟, 蔡迎春, 马俊, 等. 抗纤溶序贯抗凝平衡预防初次 THA 术后 VTE 的单中心大样本连续病例观察性研究. 中国矫形外科杂志, 2016, 24(3): 230-235.
27.	Sharrock NE, Go G, Sculco TP, et al. Changes in circulatory indices of thrombosis and fibrinolysis during total knee arthroplasty performed under tourniquet. J Arthroplasty, 1995, 10(4): 523-528.

1. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet, 2007, 370(9597): 1508-1519.
2. Lindman IS, Carlsson LV. Extremely low transfusion rates: Contemporary primary total hip and knee arthroplasties. J Arthroplasty, 2018, 33(1): 51-54.
3. Song K, Pan P, Yao Y, et al. The incidence and risk factors for allogenic blood transfusion in total knee and hip arthroplasty. J Orthop Surg Res, 2019, 14(1): 273.
4. Xu H, Zhang S, Xie J, et al. A nested case-control study on the risk factors of deep vein thrombosis for Chinese after total joint arthroplasty. J Orthop Surg Res, 2019, 14(1): 188.
5. Zhang C, Xu B, Liang G, et al. Rivaroxaban versus nadroparin for preventing deep venous thrombosis after total hip arthroplasty following femoral neck fractures: A retrospective comparative study. J Int Med Res, 2018, 46(5): 1936-1946.
6. Kinov P, Tanchev PP, Ellis M, et al. Antithrombotic prophylaxis in major orthopaedic surgery: an historical overview and update of current recommendations. Int Orthop, 2014, 38(1): 169-175.
7. Stoicea N, Moran K, Mahmoud AR, et al. Tranexamic acid use during total hip arthroplasty: A single center retrospective analysis. Medicine (Baltimore), 2018, 97(21): e10720.
8. 谢锦伟, 岳辰, 裴福兴, 等. 氨甲环酸对类风湿关节炎患者全髋关节置换围手术期失血的影响. 中华骨科杂志, 2015, 35(8): 808-812.
9. Ker K, Edwards P, Perel P, et al. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ, 2012, 344: e3054.
10. 张少云, 谢锦伟, 黄强, 等. 全膝关节置换术后多次静脉应用氨甲环酸对纤溶活性及炎症反应的影响. 中华骨科杂志, 2017, 37(23): 1483-1489.
11. 姚汝瞻, 王炳武, 潘洪发, 等. 创伤骨折手术应用氨甲环酸疗效和安全性的Meta分析. 中国循证医学杂志, 2019, 19(3): 331-337.
12. 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. 中华骨科杂志, 2016, 36(2): 65-71.
13. Yu Z, Shan P, Yang X, et al. Comparison of efficiency and safety of rivaroxaban, apixaban and enoxaparin for thromboprophylaxis after arthroplastic surgery: a meta-analysis. Biosci Rep, 2018, 38(6): BSR20180423.
14. 孙伟, 史冬泉, 庞勇, 等. 全髋关节置换术后速碧林或拜瑞妥抗凝治疗对隐性失血量的影响. 中国骨与关节损伤杂志, 2013, 28(2): 136-137.
15. 范亚楠, 温阳阳, 李文龙, 等. 氨甲环酸抗纤溶后利伐沙班应用于全髋关节置换术的研究. 中国医药导报, 2017, 14(36): 84-88.
16. Nadler SB, Hidalgo JH, Bloch T. Prediction of blood volume in normal human adults. Surgery, 1962, 51(2): 224-232.
17. Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology, 1983, 58(3): 277-280.
18. Xie J, Hu Q, Ma J, et al. Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss and the inflammatory response following enhanced-recovery primary total hip arthroplasty: a randomised clinical trial. Bone Joint J, 2017, 99-B(11): 1442-1449.
19. Lei Y, Huang Q, Huang Z, et al. Multiple-dose intravenous tranexamic acid further reduces hidden blood loss after total hip arthroplasty: A randomized controlled trial. J Arthroplasty, 2018, 33(9): 2940-2945.
20. Morrison RJM, Tsang B, Fishley W, et al. Dose optimisation of intravenous tranexamic acid for elective hip and knee arthroplasty: The effectiveness of a single pre-operative dose. Bone Joint Res, 2017, 6(8): 499-505.
21. 岑光荣, 黄培祥, 陈志冲, 等. 抗凝药物对全髋关节置换术后隐形失血的影响. 中医正骨, 2013, 25(11): 23-25.
22. Chambers S, Tidwell L, Kerkhof A, et al. Topical tranexamic acid is effective in cementless total knee arthroplasty. Orthop Clin North Am, 2020, 51(1): 7-11.
23. Sukeik M, Alshryda S, Powell J, et al. The effect of tranexamic acid on wound complications in primary total hip arthroplasty: A meta-analysis. Surgeon, 2020, 18(1): 53-61.
24. Ricket AL, Stewart DW, Wood RC, et al. Comparison of postoperative bleeding in total hip and knee arthroplasty patients receiving rivaroxaban or enoxaparin. Ann Pharmacother, 2016, 50(4): 270-275.
25. Kumar PD. Prevention and treatment of major blood loss. N Engl J Med, 2007, 357(12): 1260-1261.
26. 谢锦伟, 蔡迎春, 马俊, 等. 抗纤溶序贯抗凝平衡预防初次 THA 术后 VTE 的单中心大样本连续病例观察性研究. 中国矫形外科杂志, 2016, 24(3): 230-235.
27. Sharrock NE, Go G, Sculco TP, et al. Changes in circulatory indices of thrombosis and fibrinolysis during total knee arthroplasty performed under tourniquet. J Arthroplasty, 1995, 10(4): 523-528.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of hemostatic effect and safety in primary unilateral total hip arthroplasty receiving different anticoagulants after anti-fibrinolysis with tranexamic acid

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