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Zhou LB, Wang CC, Zhang LT, Wu T, Zhang GQ. Effectiveness of different antithrombotic agents in combination with tranexamic acid for venous thromboembolism prophylaxis and blood management after total knee replacement: a prospective randomized study. BMC Musculoskelet Disord 2023; 24:5. [PMID: 36600227 DOI: 10.1186/s12891-022-06117-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/26/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Tranexamic acid (TXA) has been widely applied in total knee arthroplasty (TKA) to significantly reduce perioperative blood loss and improve knee function recovery in patients after surgery. The choice of antithrombotic agents for venous thromboembolism (VTE) prevention after TKA is controversial. Therefore, this study aimed to compare the effects of different antithrombotic agents on patients after primary unilateral TKA in the context of applied TXA. METHODS A total of 180 patients undergoing primary unilateral TKA from October 2020 to December 2021 were included in this study. All patients were given an intraoperative drip of 60 mg/kg TXA. Thereafter, patients were divided into three groups (n = 60 each). Baseline data were comparable among the three groups. The average follow-up time was 3.02 ± 0.09 months. Group 1 enrolled patients receiving oral rivaroxaban (RA) at 10 mg, Group 2 included patients who received subcutaneous Dalteparin sodium at 2500 IU, while Group 3 included patients taking oral aspirin (ASA) at 100 mg. Patients in all the three groups received treatment once a day for 30 days at 12 h postoperatively. The primary outcomes in this study were post-treatment drainage volume and thrombotic complication rate. The secondary outcomes included hematologic parameters, transfusion rate, intraoperative blood loss, total blood loss (TBL), and bleeding complication rate. RESULTS The average drainage volume after treatment was significantly lower in Group 3 than in Group 1 and Group 2 (205.2 ± 69.0 vs 243.4 ± 72.5 vs 295.4 ± 72.5 ml, P < 0.001), and there was a significant difference between Group 1 and Group 2 (243.4 ± 72.5 mL vs 295.4 ± 72.5 mL, P < 0.001). The blood transfusion rate of Group 2 dramatically increased compared with Group 1 and Group 3 (20.0% vs 6.7% vs 5.0%, P = 0.01). The bleeding complication rate in Group 1 apparently increased relative to Group 2 and Group 3 (26.7% vs 10.0% vs 8.3%, P = 0.008). Besides, there was no significant difference in the thrombotic complication rate among the three groups. CONCLUSION Under the background of TXA application, ASA, RA, and Dalteparin sodium were all effective on preventing VTE after TKA. In addition, ASA effectively reduced post-treatment Hemoglobin (Hb) loss, drainage volume, TBL, transfusion rate, and bleeding complications compared with RA and Dalteparin sodium. TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry (ChiCTR2200060169). Date of Registration: 21/05/2022.
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Affiliation(s)
- Li-Bo Zhou
- Department of Graduate School, Qinghai University, No. 251 Ningda Road, Chengbei District, Xining, 810016, Qinghai Province, China
| | - Chao-Chao Wang
- Department of Bone and Joint Surgery, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Chengxi District, Xining, 810012, Qinghai Province, China
| | - Lan-Tao Zhang
- Department of Bone and Joint Surgery, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Chengxi District, Xining, 810012, Qinghai Province, China
| | - Tao Wu
- Department of Bone and Joint Surgery, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Chengxi District, Xining, 810012, Qinghai Province, China
| | - Guo-Qiu Zhang
- Department of Bone and Joint Surgery, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Chengxi District, Xining, 810012, Qinghai Province, China.
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Karasavvidis T, Bouris V, Xiang W, Tzavellas G, Charisis N, Palaiodimos L, Kigka V, Bourantas C, Gkiatas I. Prophylaxis for Venous Thromboembolic Events in Elective Total Hip and Total Knee Arthroplasty. Curr Pharm Des 2022; 28:771-777. [PMID: 35440299 DOI: 10.2174/1381612828666220418090928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022]
Abstract
Venous thromboembolism (VTE) is a serious complication after major orthopaedic operations, such as a total hip (THA) and knee (TKA) arthroplasty. Therefore, perioperative VTE prophylaxis is recommended; a multitude of modern options are available, including both pharmacologic (aspirin, unfractionated and lowmolecular-weight heparin, vitamin K antagonists, and novel oral anticoagulants) and/or mechanical interventions (early mobilization, graduated compression stockings, intermittent pneumatic compression devices, and venous foot pumps). However, because of the abundance of these possibilities, it is crucial to understand the benefits and drawbacks of each VTE prophylaxis option to ensure that the optimal treatment plan is developed for each patient. The American College of Chest Physicians (AACP) and the American Academy of Orthopaedic Surgeons (AAOS) have both published individual guidelines on VTE prophylaxis regimens, alongside numerous studies evaluating the efficacy and outcomes of the different prophylaxis modalities. The purpose of this review is to provide a summary of the evidence on VTE prophylaxis after elective total hip and knee arthroplasty based on current guidelines and highlight the major concerns and potential complications.
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Affiliation(s)
| | - Vasileios Bouris
- Department of Vascular Surgery, General Hospital of Athens G. Genimatas, Athens, Greece
| | - William Xiang
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, New York, NY, USA
| | | | - Nektarios Charisis
- Department of Surgery, Stony Brook University Hospital, Stony Brook, NY, USA
| | | | - Vassiliki Kigka
- School of Medicine, University of Ioannina, Ioannina, Greece
| | | | - Ioannis Gkiatas
- Hospital for Special Surgery, Stavros Niarchos Foundation Complex Joint Reconstruction Center, New York, NY, USA
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Bai CW, Ruan RX, Pan S, Huang CR, Zhang XC, Pang Y, Zheng X, Guo KJ. Application of thromboelastography in comparing coagulation difference of rivaroxaban and enoxaparin for thromboprophylaxis after total hip arthroplasty. J Orthop Surg (Hong Kong) 2021; 29:23094990211042674. [PMID: 34550034 DOI: 10.1177/23094990211042674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: The purpose of this study was to compare the coagulation difference in patients with either rivaroxaban or enoxaparin as thromboprophylaxis after total hip arthroplasty (THA) regarding thromboelastography (TEG) and routine coagulation tests. Patients and methods: Two hundred and twenty-eight patients undergoing primary THA were recruited in this study. They were divided into two groups according to a computer-generated random sequence. Patients in the rivaroxaban group received 10 mg of rivaroxaban orally once daily. Patients in the enoxaparin group received 4000 AxaIU (0.4 mL) of enoxaparin subcutaneously once daily. Rivaroxaban and enoxaparin were started 6-8 h after surgery. The administration of the anticoagulant prophylaxis was lasted for a minimum of 14 days. TEG and routine coagulation tests were performed on the day before the operation and 1 day and 7 days after the operation. Results: No difference was observed in the incidence of deep vein thrombosis (DVT) or pulmonary embolism (PE) between the two groups. There was no significant difference with regard to prothrombin time (PT), activated partial thromboplastin time (PTT), international normalized ratio (INR), and thrombin time (TT) between the two groups. However, while considering TEG, R time of the rivaroxaban group was significantly higher than that of the enoxaparin group (p = 0.003), whereas the maximum amplitude (MA) (p = 0.036) value and coagulation index (CI) (p = 0.002) value were significantly lower than those of the enoxaparin group. Conclusion: With regard to TEG analysis, there was coagulation difference in patients with rivaroxaban and those with enoxaparin as thromboprophylaxis after THA. Under recommended dose of rivaroxaban and enoxaparin, patients undergoing THA were in hypercoagulability on 7days postoperative.
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Affiliation(s)
- Chao-Wen Bai
- Department of Orthopaedic Surgery, 117910The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Orthopaedic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ru-Xin Ruan
- Department of Orthopaedic Surgery, 117910The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Sheng Pan
- Department of Orthopaedic Surgery, 117910The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chao-Ran Huang
- Department of Orthopaedic Surgery, 117910The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xing-Chen Zhang
- Department of Orthopaedic Surgery, 117910The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yong Pang
- Department of Orthopaedic Surgery, 117910The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xin Zheng
- Department of Orthopaedic Surgery, 117910The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Department of Orthopaedic Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou China
| | - Kai-Jin Guo
- Department of Orthopaedic Surgery, 117910The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Wang M, Xie J, Zheng H, Wang S, Zhou R, Li W, Xue E, Wang X, Jiang J, Wu T, Zhan S. Wound complications and bleeding with new oral anticoagulants in patients undergoing total joint arthroplasty: A systematic review and meta-analysis of randomized controlled trials. Br J Clin Pharmacol 2021; 88:500-513. [PMID: 34322914 DOI: 10.1111/bcp.15005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/18/2021] [Accepted: 07/15/2021] [Indexed: 02/05/2023] Open
Abstract
AIMS The results of associations between new oral anticoagulants (NOACs) and wound complications after total joint arthroplasty remain inconsistent. We conducted a systematic review and meta-analysis of randomized controlled trials to make comparisons with low molecular weight heparins (LMWH) on the clinical outcomes of total wound complications, together with other efficacy and safety endpoints to further evaluate the safety and efficacy of NOACs. METHODS This meta-analysis was conducted based on a published protocol (PROSPERO: CRD42019140841). We searched for available articles in PubMed, Embase and Cochrane Library through Jun 62 021. Random-effects meta-analyses, including subgroup analyses, were conducted to estimate the pooled relative risk (RR) and 95% confidence interval (CI) for specific doses of NOACs. RESULTS We retrieved 1683 studies, of which 20 were eligible for inclusion. We found that apixaban was associated with a lower incidence of total wound complications compared with LMWH (RR = 0.81; 95% CI: 0.65-1.00), while dabigatran and rivaroxaban did not increase the risk of total wound complications. In addition, apixaban was associated with a reduction in the risk of major/clinically relevant nonmajor bleeding events compared to LMWH (RR = 0.80, 95% CI: 0.65-0.99), while rivaroxaban increased the risk for major/clinically relevant nonmajor bleeding events (RR = 1.23, 95% CI: 1.02-1.50). Moreover, all 4 NOACs were associated with lower incidences of major venous thromboembolism compared with LMWH. CONCLUSION A lower risk of wound complications was detected for apixaban, while dabigatran and rivaroxaban did not increase the risk when compared with LMWH. The efficacy of 4 NOACs was broadly similar.
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Affiliation(s)
- Mengying Wang
- School of Public Health, Peking University, Beijing, China
| | - Jinwei Xie
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Hongchen Zheng
- School of Public Health, Peking University, Beijing, China
| | - Siyue Wang
- School of Public Health, Peking University, Beijing, China
| | - Ren Zhou
- School of Public Health, Peking University, Beijing, China
| | - Wenyong Li
- School of Public Health, Peking University, Beijing, China
| | - Enci Xue
- School of Public Health, Peking University, Beijing, China
| | - Xueheng Wang
- School of Public Health, Peking University, Beijing, China
| | - Jin Jiang
- School of Public Health, Peking University, Beijing, China
| | - Tao Wu
- School of Public Health, Peking University, Beijing, China.,Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, China
| | - Siyan Zhan
- School of Public Health, Peking University, Beijing, China
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Yang QF, Lin ZM, Yang S, Wang PK, Chen R, Wang J. Incidence and Risk Factors of In-Hospital Prosthesis-Related Complications Following Total Knee Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study. Orthop Surg 2021; 13:1579-1586. [PMID: 34109750 PMCID: PMC8313154 DOI: 10.1111/os.13008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/13/2021] [Accepted: 03/11/2021] [Indexed: 01/28/2023] Open
Abstract
Objective To examine the incidence and risk factors of in‐hospital prosthesis‐related complications (PRCs) following total knee arthroplasty (TKA) using a large‐scale national database. Methods A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005–2014. Patients who underwent TKA were included. The recruited cases were divided into two groups according to the occurrence of PRCs. Patient demographics (age, sex, and race), hospital characteristics (type of admission and payer, and bedsize, teaching status, location, and region of hospital), length of stay (LOS), total charges during hospitalization, in‐hospital mortality, comorbidities, and perioperative complications were analyzed. Results A total of 1,227,244 TKAs were captured from the NIS database. There were 8484 cases of in‐hospital PRCs after TKA and the overall incidence was 0.69%, with a slight downward trend annually. Periprosthetic joint infection (PJI) was the main category among PRCs (0.20%), followed by mechanical loosening (0.04%), dislocation (0.02%), and periprosthetic fracture (PPF) (0.01%). Patients suffered from in‐hospital PRCs were 3 years younger (64 years vs 67 years) and 6.51% more likely to be male (43.60% vs 37.09%) compared to the nonaffected population (P < 0.0001). Additionally, patients experiencing in‐hospital PRCs after TKA were 2.11% less likely through elective admission (92.07% vs 94.18%) while 2.34% more likely in teaching hospital (45.53% vs 43.19%) than those without these complications (P < 0.0001). Furthermore, the occurrence of in‐hospital PRCs was associated with longer LOS (4 days vs 3 days; P < 0.0001), more total charges ($53,418 vs $41,204, P < 0.0001), and higher in‐hospital mortality (0.30% vs 0.07%; P < 0.0001). Multivariate logistic regression was performed to identify independent risk factors of in‐hospital PRCs after TKA which included younger age, male, non‐elective admission, teaching hospital, deficiency and chronic blood loss anemia, coagulopathy, congestive heart failure, depression, diabetes with chronic complications, fluid and electrolyte disorders, pulmonary circulation disorders, metastatic cancer, and weight loss. Besides, in‐hospital PRCs after TKA were associated with secondary osteoarthritis, inflammatory arthritis, prior knee arthroscopy, acute renal failure, acute myocardial infarction, deep vein thrombosis, sepsis, transfusion, and wound dehiscence. Conclusion It is beneficial to study the risk factors of in‐hospital PRCs after TKA to ensure the appropriate management and optimize consequences although a relatively low incidence was identified.
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Affiliation(s)
- Qin-Feng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ze-Ming Lin
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sheng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pin-Kai Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rong Chen
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Heidemann J, Tanislav C, Kostev K. (Absence of) Association Between Non-Vitamin K Antagonist Oral Anticoagulant Therapy and Urinary Tract Infection in Patients With Atrial Fibrillation. J Cardiovasc Pharmacol 2021; 77:830-834. [PMID: 34016840 DOI: 10.1097/fjc.0000000000001020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/13/2021] [Indexed: 12/26/2022]
Abstract
ABSTRACT The aim of the present study is to identify a potential association of urinary tract infections (UTI) in a large population of patients receiving oral anticoagulation therapy treated in general practices in Germany. This study contains patients diagnosed with atrial fibrillation who received at least one prescription of either non-vitamin K antagonist oral anticoagulation (NOAC) or vitamin K antagonists (VKA) within January 2015 and December 2018. The incidence of UTI was examined cumulatively on the basis of Kaplan-Meier methods and was complemented by incidence rates measured in cases per 1000 patient years. Sex-stratified Cox regressions were conducted to examine possible associations in specific sex groups. The study comprised 26,934 patients receiving NOAC therapy and 8121 patients treated with VKA agents. Within a period of 5 years, slightly more NOAC than VKA users were diagnosed with UTI (20.3% vs. 19.3%), whereas the incidence rate was slightly higher in patients receiving NOAC therapy than in those under VKA treatment (50.8 cases vs. 50.5 cases in 1000 patient years). There was no significant association between direct oral anticoagulants versus vitamin K antagonists and infections of the urinary tract. Our study did not identify any significant association between therapy with direct oral anticoagulants versus vitamin K anticoagulants and UTI in patients diagnosed with atrial fibrillation in general practices in Germany. Because current findings regarding the risk of UTI in patients receiving oral anticoagulation therapy remain limited and contradictory, further investigations including a broad patient population are necessary to determine patients at risk for UTI and reconcile conflicting evidence.
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Affiliation(s)
| | - Christian Tanislav
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling Siegen, Germany
| | - Karel Kostev
- Epidemiology, IQVIA, Frankfurt am Main, Germany ; and
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Gonzalez Della Valle A, Shanaghan KA, Nguyen J, Liu J, Memtsoudis S, Sharrock NE, Salvati EA. Multimodal prophylaxis in patients with a history of venous thromboembolism undergoing primary elective hip arthroplasty. Bone Joint J 2020; 102-B:71-77. [DOI: 10.1302/0301-620x.102b7.bjj-2019-1559.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims We studied the safety and efficacy of multimodal thromboprophylaxis in patients with a history of venous thromboembolism (VTE) who undergo total hip arthroplasty (THA) within the first 120 postoperative days, and the mortality during the first year. Multimodal prophylaxis includes discontinuation of procoagulant medications, VTE risk stratification, regional anaesthesia, an intravenous bolus of unfractionated heparin prior to femoral preparation, rapid mobilization, the use of pneumatic compression devices, and chemoprophylaxis tailored to the patient’s risk of VTE. Methods Between 2004 to 2018, 257 patients with a proven history of VTE underwent 277 primary elective THA procedures by two surgeons at a single institution. The patients had a history of deep vein thrombosis (DVT) (186, 67%), pulmonary embolism (PE) (43, 15.5%), or both (48, 17.5%). Chemoprophylaxis included aspirin (38 patients), anticoagulation (215 patients), or a combination of aspirin and anticoagulation (24 patients). A total of 50 patients (18%) had a vena cava filter in situ at the time of surgery. Patients were followed for 120 days to record complications, and for one year to record mortality. Results Postoperative VTE was diagnosed in seven patients (2.5%): DVT in five, and PE with and without DVT in one patient each. After hospitalization, three patients required readmiss-ion for evacuation of a haematoma, one for wound drainage, and one for monitoring of an elevated international normalized ratio (INR). Seven patients died (2.5%). One patient died five months postoperatively of a PE during open thrombectomy. She had discontinued anticoagulation. One patient died of a haemorrhagic stroke while receiving Coumadin. PE or bleeding was not suspected in the remaining five fatalities. Conclusion Multimodal prophylaxis is safe and effective in patients with a history of VTE. Postoperative anticoagulation should be prudent as very few patients developed VTE (2.5%) or died of suspected or confirmed PE. Mortality during the first year was mostly unrelated to either VTE or bleeding. Cite this article: Bone Joint J 2020;102-B(7 Supple B):71–77.
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Affiliation(s)
- Alejandro Gonzalez Della Valle
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Kate A. Shanaghan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Joseph Nguyen
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Jiabin Liu
- Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Stavros Memtsoudis
- Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Nigel E. Sharrock
- Department of Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Eduardo A. Salvati
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College of Cornell University, New York, New York, USA
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Yang Q, Wang J, Xu Y, Chen Y, Lian Q, Zhang Y. Incidence and risk factors of in-hospital prosthesis-related complications following total hip arthroplasty: a retrospective Nationwide Inpatient Sample database study. International Orthopaedics (SICOT) 2020; 44:2243-2252. [DOI: 10.1007/s00264-020-04682-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022]
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Teo BJX, Yeo W, Chong HC, Tan AHC. Surgical site infection after primary total knee arthroplasty is associated with a longer duration of surgery. J Orthop Surg (Hong Kong) 2019; 26:2309499018785647. [PMID: 30010488 DOI: 10.1177/2309499018785647] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Surgical site infection (SSI) is a serious complication following total knee arthroplasty (TKA) leading to considerable morbidity. The incidence is reported to be up to 2%. Risk factors continue to be an area of intense debate. Our study aims to report the incidence of SSI and identify possible risk factors in our patients undergoing TKA. METHODS Prospectively collected data for 905 patients who underwent elective unilateral TKA by a single surgeon from February 2004 to July 2014 were reviewed. Patient demographics and relevant co-morbidities such as diabetes and heart disease were analysed. The presence of superficial wound infections and/or prosthetic joint infections was included. RESULTS The overall infection rate was 1.10% (10 of 905 patients). Six patients (0.66%) were diagnosed with superficial infections and four with PJI (0.44%). The mean operative duration for TKA with SSI was significantly longer at 90.5 ± 28.2 min, compared to 72.2 ± 20.3 min in TKA without SSI ( p = 0.03). All superficial infections occurred within the first month post-surgery and were self-limiting with oral antibiotics. The four patients with PJI required repeated procedures following TKA, including debridement, implant removal and/or revision arthroplasty. None of the 10 patients had a history of diabetes. There were no significant differences in demographics and co-morbidities between those who developed infection after TKA and those who did not. CONCLUSION An overwhelming majority had good outcomes with only four deep infections resulting in revision surgery. We report that the risk of infection in TKA was significantly associated with a longer operative duration.
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Affiliation(s)
- Bryon Jun Xiong Teo
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - William Yeo
- 2 Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - Hwei-Chi Chong
- 2 Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - Andrew Hwee Chye Tan
- 1 Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Glassberg MB, Lachiewicz PF. Changing Patterns of Anticoagulation After Total Hip Arthroplasty in the United States: Frequency of Deep Vein Thrombosis, Pulmonary Embolism, and Complications With Rivaroxaban and Warfarin. J Arthroplasty 2019; 34:1793-801. [PMID: 31005440 DOI: 10.1016/j.arth.2019.03.057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 03/22/2019] [Accepted: 03/25/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study evaluated the trends in anticoagulation use after total hip arthroplasty (THA), and the effectiveness and safety of rivaroxaban compared to warfarin. METHODS This retrospective database analysis used healthcare claims from the Truven Health MarketScan database (2010-2015). Patients undergoing elective THA were followed for use of anticoagulants after surgery. Logistic regression models were used to compare differences in deep vein thrombosis (DVT), pulmonary embolism (PE), and adverse events, within 90 days after THA, among warfarin and rivaroxaban users. Inverse probability treatment weighting was used to account for selection bias. RESULTS There were 12,876 users of warfarin and 10,892 users of rivaroxaban in commercially insured (CI) patients, and 7416 warfarin users and 4739 rivaroxaban users in Medicare supplement (MS) patients. Warfarin use decreased over time in both insurance cohorts, whereas rivaroxaban use increased from 2011 to 2015. Warfarin users were significantly more likely to experience both DVT (CI: odds ratio [OR] 2.63, 95% confidence interval 1.97-3.50; MS: OR 1.78, 95% confidence interval 1.38-2.29) and PE (CI: OR 2.60, 95% confidence interval 2.04-3.31; MS: OR 2.09, 95% confidence interval 1.66-2.65). There was no significant difference in rates of bleeding between the 2 agents, but warfarin users had higher odds of periprosthetic joint infection in both cohorts (CI: OR 1.57, 95% confidence interval 1.16-2.13; MS: OR 1.79, 95% confidence interval 1.14-2.81). CONCLUSION There has been an increase in prophylaxis with rivaroxaban, and a decrease in warfarin use after elective THA over 4 years. Warfarin users were more likely to experience DVT and PE than rivaroxaban, and bleeding risks were similar.
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Arnold WV, Bari AK, Buttaro M, Huang R, Mirez JP, Neira I, Poojary A, Purtill JJ, Quevedo MS, García Ricaurte JC, Scuderi G, Thakur H, Tozun IR. General Assembly, Prevention, Postoperative Factors: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S169-S174. [PMID: 30348574 DOI: 10.1016/j.arth.2018.09.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Trivedi NN, Fitzgerald SJ, Schmaier AH, Wera GD. Venous Thromboembolism Chemoprophylaxis in Total Hip and Knee Arthroplasty: A Critical Analysis Review. JBJS Rev 2019; 7:e2. [PMID: 30601202 DOI: 10.2106/jbjs.rvw.18.00010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nikunj N Trivedi
- University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Steven J Fitzgerald
- University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Alvin H Schmaier
- University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Glenn D Wera
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Abstract
Total hip replacement is a frequently done and highly successful surgical intervention. The procedure is undertaken to relieve pain and improve function in individuals with advanced arthritis of the hip joint. Symptomatic osteoarthritis is the most common indication for surgery. In paper 1 of this Series, we focus on how patient factors should inform the surgical decision-making process. Substantial demands are placed upon modern implants, because patients expect to remain active for longer. We discuss the advances made in implant performance and the developments in perioperative practice that have reduced complications. Assessment of surgery outcomes should include patient-reported outcome measures and implant survival rates that are based on data from joint replacement registries. The high-profile failure of some widely used metal-on-metal prostheses has shown the shortcomings of the existing regulatory framework. We consider how proposed changes to the regulatory framework could influence safety.
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Affiliation(s)
- Rory J Ferguson
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - Antony Jr Palmer
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Adrian Taylor
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Henrik Malchau
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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16
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Kim YT, Kang MW, Lee JK, Lee YM, Kim JI. Combined use of topical intraarticular tranexamic acid and rivaroxaban in total knee arthroplasty safely reduces blood loss, transfusion rates, and wound complications without increasing the risk of thrombosis. BMC Musculoskelet Disord 2018; 19:227. [PMID: 30021575 PMCID: PMC6052595 DOI: 10.1186/s12891-018-2151-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/21/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Blood loss and deep vein thrombosis (DVT) are important complications after total knee arthroplasty (TKA). Topical tranexamic acid (TXA) effectively reduces wound bleeding but may elevate the risk of DVT. In contrast, rivaroxaban potently prevents DVT but has been associated with bleeding complications. The simultaneous use of topical TXA and rivaroxaban in TKA has not been much investigated. METHODS A retrospective cohort study was conducted with two consecutive groups of patients who underwent TKA. Intraoperatively, one group (RVTX group) received topical, intraarticular TXA, while the other (RV group) did not. Both groups were administered rivaroxaban postoperatively for 14 days and underwent Doppler ultrasound for DVT screening. After propensity score matching, both groups consisted of 52 patients (104 patients in total) and were compared regarding total drain output, nadir haemoglobin (Hb), maximum Hb decrease, calculated total blood loss, transfusion rate, and incidence of DVT and wound complications. RESULTS Both groups showed no significant differences in the propensity-matched variables of age, sex, body mass index, American Society of Anesthesiologists physical status score, and preoperative Hb. The RVTX group showed a significantly higher nadir Hb (p < 0.001), lower drain output (p < 0.001), Hb decrease (p = 0.015), total blood loss (p < 0.001), and rate of transfusion (p < 0.001) and fewer wound complications (p = 0.027). However, the incidence of DVT (p = 1.000) did not differ significantly between the two groups, and all cases were asymptomatic. CONCLUSIONS The combined use of intraarticular topical TXA with rivaroxaban in patients undergoing TKA is a safe and effective method to reduce blood loss, the need for transfusion, and wound complications without elevating the risk of DVT.
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Affiliation(s)
- Yong Tae Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 150-950, South Korea
| | - Min Wook Kang
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 150-950, South Korea
| | - Joon Kyu Lee
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, 431-796, South Korea
| | - Young Min Lee
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 150-950, South Korea
| | - Joong Il Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 150-950, South Korea.
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17
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Abstract
The blood coagulation system and immune system of higher organisms are thought to have a common ancestral origin. During infections, the blood coagulation system is activated and components of the hemostatic system are directly involved in the immune response and immune system modulations. The current view is that the activation of coagulation is beneficial for infections with bacteria and viruses. It limits pathogen dissemination and supports pathogen killing and tissue repair. On the other hand, over-activation can lead to thrombosis with subsequent depletion of hemostatic factors and secondary bleeding. This review will summarize the current knowledge on blood coagulation and pathogen infection with focus on most recent studies of the role of the different parts of the blood coagulation system in selected bacterial and viral infections.
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Affiliation(s)
- Silvio Antoniak
- Program in Thrombosis and HemostasisDepartment of Pathology and Laboratory MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
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18
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Lum ZC, Monzon RA, Bosque J, Coleman S, Pereira GC, Di Cesare PE. Effects of fondaparinux on wound drainage after total hip and knee arthroplasty. J Orthop 2018; 15:388-390. [PMID: 29881160 DOI: 10.1016/j.jor.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 03/16/2018] [Indexed: 01/22/2023] Open
Abstract
Background The purpose of this investigation was to determine the effects of fondaparinux on postoperative wound drainage, length of hospital stay (LOS) and rate of surgical site infection in total joint patients. Methods 117 patients undergoing total joint arthroplasty treated with fondaparinux for venous thromboembolism (VTE) prophylaxis were prospectively studied. Results The average time to a dry wound was 3.4 days, with an average LOS of 3.77 days. Perioperative complications included 2 cases each of superficial cellulitis, deep vein thrombosis, and pulmonary embolism; there were no cases of deep infection. Multi-variate analysis showed increased patient BMI increased LOS (p = 0.0169). Conclusion Fondaparinux is an effective drug for VTE prophylaxis in total joint arthroplasty with wound drainage and LOS comparable to historical controls of enoxaparin, warfarin, and rivaroxaban.
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Affiliation(s)
- Zachary C Lum
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
| | - Rene A Monzon
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
| | - Jose Bosque
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
| | - Sheldon Coleman
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
| | - Gavin C Pereira
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
| | - Paul E Di Cesare
- University of California: Davis Medical Center, Adult Reconstruction, Department of Orthopaedics, 4860 Y Street, Suite #3800, Sacramento, CA 95817, United States
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Almustafa MA, Ewen AM, Deakin AH, Picard F, Clarke JV, Mahmood FF. Risk Factors for Surgical Site Infection Following Lower Limb Arthroplasty: A Retrospective Cohort Analysis of 3932 Lower Limb Arthroplasty Procedures in a High Volume Arthroplasty Unit. J Arthroplasty 2018; 33:1861-1867. [PMID: 29506934 DOI: 10.1016/j.arth.2018.01.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 01/10/2018] [Accepted: 01/22/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) is a debilitating complication of lower limb arthroplasty with significant morbidity and increased costs. Numerous risk factors are associated with SSI. METHODS In an effort to identify novel risk factors for SSI, we undertook a retrospective cohort study of 1832 primary total hip arthroplasties and 2100 primary total knee arthroplasties performed in our high volume arthroplasty unit over a 2-year period. RESULTS Two risk factors were identified for SSI following total hip arthroplasty: body mass index ≥30 and peri-operative blood transfusion. Eight risk factors were identified for SSI following total knee arthroplasty: hypertension, peri-operative blood transfusion, skin closure using 2-octyl cyanoacrylate, use of oral steroids, reduced serum mean cell volume, reduced mean cell hemoglobin, elevated serum neutrophil count, and use of warfarin or rivaroxaban for venous thromboembolism prophylaxis. CONCLUSIONS Our work proposes a number of previously undocumented risk factors in relation to SSI. Further investigation is required to ascertain the magnitude of their effect.
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Affiliation(s)
| | | | | | | | - Jon V Clarke
- Golden Jubilee National Hospital, Clydebank, United Kingdom
| | - Fahd F Mahmood
- Golden Jubilee National Hospital, Clydebank, United Kingdom
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Bozhkova SA, Kasimova AR, Nakopia VB, Kornilov NN. DO WE KNOW ALL ABOUT PREVENTION OF VENOUS THROMBOEMBOLISM AFTER MAJOR ORTHOPEDIC SURGERY? Travmatol ortop Ross 2018. [DOI: 10.21823/2311-2905-2018-24-1-129-143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Kraeutler MJ, Raju S, Garabekyan T, Mei-Dan O. Incidence of deep venous thrombosis following periacetabular and derotational femoral osteotomy: a case for mechanical prophylaxis. J Hip Preserv Surg 2018; 5:119-124. [PMID: 29876127 PMCID: PMC5961113 DOI: 10.1093/jhps/hny008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/29/2017] [Accepted: 02/11/2018] [Indexed: 02/02/2023] Open
Abstract
There are currently no established guidelines for appropriate antithrombotic prophylaxis following periacetabular osteotomy (PAO) or derotational femoral osteotomy (DFO). The purpose of this study was to determine the incidence of clinical deep venous thrombosis (DVT) following PAO and/or DFO wherein a portable, mechanical device and low-dose aspirin were used postoperatively for DVT prophylaxis. Patients who had undergone staged hip arthroscopy and primary PAO and/or DFO were prospectively reviewed. Following PAO/DFO, patients were prophylactically treated for thromboembolic disease with a portable, mechanical compression device for 3 weeks and low-dose aspirin for 4 weeks. Patients were followed in clinic until 24 months postoperatively. During the study period, 145 hips (124 patients) underwent surgery (PAO: 109, DFO: 24, PAO + DFO: 12). Overall, the incidence of clinically apparent DVT was 0% in the study cohort. Average estimated blood loss during surgery was 601 mL and five cases required blood transfusions of 1 or 2 units. Ten patients were seen in the emergency room 10–20 days after surgery presenting with calf tenderness and DVT was ruled out in all cases with ultrasound. There were no postoperative bleeding or wound complications. A portable, mechanical compression device and low-dose aspirin effectively lessens the risk of DVT following staged hip arthroscopy and PAO/DFO without an increased risk of bleeding complications.
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Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopaedics, Seton Hall-Hackensack Meridian School of Medicine, 400 S Orange Ave, South Orange, NJ 07079, USA
| | - Sivashanmugam Raju
- Department of Orthopedics, University of Colorado School of Medicine, 12631 East 17 Avenue, Mail Stop B202, Room L15-4505, Aurora, CO 80045, USA
| | - Tigran Garabekyan
- Southern California Hip Institute, 10640 Riverside Dr, North Hollywood, CA 91602, USA
| | - Omer Mei-Dan
- Department of Orthopedics, University of Colorado School of Medicine, 12631 East 17 Avenue, Mail Stop B202, Room L15-4505, Aurora, CO 80045, USA
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22
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Hamza SH, Reynolds P. The practice pattern of anticoagulation prophylaxis for patients undergoing total hip replacement in a major orthopaedic centre; a retrospective review. Hip Int 2018; 28:178-81. [PMID: 28885651 DOI: 10.5301/hipint.5000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
METHODS In a major centre for orthopaedic surgery, we retrospectively analysed 1,469 patients who underwent elective hip replacement since 2010. All patients but 2 received anticoagulation postoperatively and rivaroxaban was the preferred choice for anticoagulation. RESULTS The incidence of all adverse events in those who received rivaroxaban was 1.7%. Only 0.3% had a minor upper gastrointestinal bleed and 1.3% developed a minor wound bleeding or haematoma. The occurrence of symptomatic venous thromboembolism (VTE) was 0.2% of all patients. CONCLUSIONS In this analysis, the incidence of adverse events was lower than the previously 4 published national figures.
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23
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Garfinkel JH, Gladnick BP, Roland N, Romness DW. Increased Incidence of Bleeding and Wound Complications With Factor-Xa Inhibitors After Total Joint Arthroplasty. J Arthroplasty 2018; 33:533-536. [PMID: 28947374 DOI: 10.1016/j.arth.2017.08.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/12/2017] [Accepted: 08/29/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Factor-Xa inhibitors have been introduced for prevention of venous thromboembolism (VTE) after joint arthroplasty. However, these agents could also be associated with bleeding or wound complications after surgery. METHODS We retrospectively reviewed a consecutive series of 59 patients (31 knees, 28 hips) undergoing joint arthroplasty at a high-volume joint arthroplasty referral center, both before and after implementation of a new VTE risk-stratification tool at our institution. Patients with a history of VTE, bilateral procedures, or medical conditions already requiring VTE chemoprophylaxis were excluded. We reviewed the medical records to determine (1) type of VTE prophylaxis used, (2) incidence of bleeding/wound complications in the postoperative period, (3) incidence of VTE in the postoperative period, and (4) change in serum hemoglobin. RESULTS Twenty-seven patients (46%) were given aspirin for VTE prophylaxis, while 32 patients (54%) received a factor-Xa inhibitor. There were no new VTE complications in either group. And 6 of 32 patients (18.7%) in the Xa inhibitor group had a postoperative bleeding/wound complication (4 delayed healing/blistering, 1 hematoma/excessive ecchymosis, and 1 readmission for cellulitis). There were no (0%) bleeding/wound complications in the aspirin group (P = .03). The change in hemoglobin level was -2.76 g/dL in patients receiving aspirin vs -2.84 g/dL in patients receiving a Xa inhibitor (P = .73). CONCLUSION In our study of total joint patients, factor-Xa inhibitors were associated with a higher incidence of bleeding/wound complications. The choice of VTE prophylaxis should be based on the perceived risks of bleeding and wound complications compared to the risks of VTE in each patient.
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Affiliation(s)
| | - Brian P Gladnick
- OrthoVirginia, Adult Hip and Knee Reconstruction, Arlington, Virginia; Virginia Hospital Center, Arlington, Virginia
| | | | - David W Romness
- OrthoVirginia, Adult Hip and Knee Reconstruction, Arlington, Virginia; Virginia Hospital Center, Arlington, Virginia
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24
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Di Benedetto P, Zangari A, De Franceschi D, Di Benedetto ED, Cainero V, Beltrame A, Gisonni R, Causero A. Rivaroxaban and early periprostethic joint infection: our experience. Acta Biomed 2017; 88:38-42. [PMID: 29083351 DOI: 10.23750/abm.v88i4 -s.6792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Periprostethic joint infection (PJI) is a severe post-operative complication after Primary Total Hip Arthroplasty (THA). According to the classification of PJI early acute PJI occurs within 4 weeks from surgery. Some authors think that Rivaroxaban is a risk factor in the incidence of early acute PJI. We analyze our experience about this item. MATERIALS AND METHODS We analyze our experience from 1st January 2015 to 31th December 2016. We consider all consecutive hip arthroplasty implants in this period. RESULTS In the 205 patients analysed we not find early acute PJI in Rivaroxaban group nor in the others assuming another kind of thromboprophylaxis. CONCLUSIONS In our series there is no evidence of association between Rivaroxaban and early acute PJI. This is a retrospective cohort study, so we need more studies and more robust experimental designs to confirm these results.
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25
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Affiliation(s)
- James T Ninomiya
- 1Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin 2West Texas Orthopedics, Midland, Texas 3Houston Methodist Hospital, Houston, Texas
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26
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Affiliation(s)
- Antonia F Chen
- 1Rothman Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 2John Peter Smith Hospital, Fort Worth, Texas 3Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 4University of Arizona, College of Medicine-Phoenix, Phoenix, Arizona
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28
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Papadopoulos DV, Kostas-Agnantis I, Gkiatas I, Tsantes AG, Ziara P, Korompilias AV. The role of new oral anticoagulants in orthopaedics: an update of recent evidence. Eur J Orthop Surg Traumatol 2017; 27:573-582. [DOI: 10.1007/s00590-017-1940-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/05/2017] [Indexed: 12/27/2022]
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29
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Wang JW, Chen B, Lin PC, Yen SH, Huang CC, Kuo FC. The Efficacy of Combined Use of Rivaroxaban and Tranexamic Acid on Blood Conservation in Minimally Invasive Total Knee Arthroplasty a Double-Blind Randomized, Controlled Trial. J Arthroplasty 2017; 32:801-806. [PMID: 27663190 DOI: 10.1016/j.arth.2016.08.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Tranexamic acid (TXA) was reportedly to decrease postoperative blood loss after standard total knee arthroplasty (TKA). However, the blood-conservation effect of TXA in minimally invasive TKA, in particular, receiving a direct oral anticoagulant was unclear. The aim of the study was to investigate the efficacy of combined use of TXA and rivaroxaban on postoperative blood loss in primary minimally invasive TKA. METHODS In a prospective, randomized, controlled trial, 198 patients were assigned to placebo (98 patients, normal saline injection) and study group (100 patients, 1g TXA intraoperative injection) during primary unilateral minimally invasive TKA. All patients received rivaroxaban 10 mg each day for 14 doses postoperatively. Total blood loss was calculated from the maximum hemoglobin drop after surgery plus amount of transfusion. The transfusion rate and wound complications were recorded in all patients. Deep-vein thrombosis was detected by ascending venography of the leg 15 days postoperatively. RESULTS The mean total blood loss was lower in the study group (1020 mL [95% confidence interval, 960-1080 mL]) compared with placebo (1202 mL [95% confidence interval, 1137-1268 mL]) (P < .001). The transfusion rate was lower in the study group compared with placebo (1% vs 8.2%, P = .018). Postoperative wound hematoma and ecchymosis were higher in placebo than the study group (P = .003). There was no symptomatic deep-vein thrombosis or pulmonary embolism in either group. CONCLUSION Systemic administration of TXA can effectively reduce the postoperative blood loss which results in lower rate of transfusion requirement and wound hematoma in minimally invasive TKA patients when rivaroxaban is used for thromboprophylaxis. Rivaroxaban has a high rate of bleeding complications when used alone in TKA patients.
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Affiliation(s)
- Jun-Wen Wang
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Bradley Chen
- Institute of Public Health, National Yangming University, Taipei, Taiwan
| | - Po-Chun Lin
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Shih-Hsiang Yen
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chung-Cheng Huang
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Feng-Chih Kuo
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
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30
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Klika AK, Brimmo O, Murray TG, Molloy R, Higuera CA. Response to Letter to the Editor on "Rivaroxaban Use for Thromboprophylaxis Is Associated With Early Periprosthetic Joint Infection". J Arthroplasty 2016; 31:2079-80. [PMID: 27341972 DOI: 10.1016/j.arth.2016.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/10/2016] [Indexed: 02/01/2023] Open
Affiliation(s)
- Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Olubusola Brimmo
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Trevor G Murray
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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31
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Llinás AM, Bautista MP, Bonilla GA, Muskus MA, Monsalvo DJ. Letter to the Editor on "Rivaroxaban Use for Thrombosis Prophylaxis is Associated With Early Periprosthetic Joint Infection". J Arthroplasty 2016; 31:2079. [PMID: 27329579 DOI: 10.1016/j.arth.2016.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 05/10/2016] [Indexed: 02/01/2023] Open
Affiliation(s)
- Adolfo M Llinás
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; School of Medicine, Universidad de Los Andes, Bogotá, Colombia; School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Maria P Bautista
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Guillermo A Bonilla
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; School of Medicine, Universidad de Los Andes, Bogotá, Colombia; School of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Meilyn A Muskus
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Daniel J Monsalvo
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
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