Clinical efficacy of rivaroxaban combined with topical application of tranexamic acid in primary total hip arthroplasty

doi:10.3877/cma.j.issn.1674-134X.2018.03.001

Abstract

Abstract:

Objective

To explore the effect of rivaroxaban combined with local use of tranexamic acid in primary total hip arthroplasty(THA).

Methods

Inclusion criteria: age≥60 years, primary THA, no rivaroxaban and ammoniacal acid allergy. Exclusion criteria: deep venous thrombosis, pulmonary embolism or abnormal preoperative blood vessels, abnormal blood routine and blood coagulation dysfunction, cardiovascular and cerebrovascular diseases, severe cardiopulmonary renal insufficiency. A total of 146 patients undergoing primary total hip arthroplasty in the orthopedic department of the Second Affiliated Hospital of Xi’an Jiaotong University from January 2012 to January 2014 were selected and divided into the rivaroxaban + tranexamic acid group (the treatment group, n=73) and the rivaroxaban group(the control group, n=73). The following continuous variables were analyzed by t test: age, body mass index(BMI), operation time, total and intraoperative blood loss, drainage volume, preoperative hemoglobin(Hb), hematocrit(HCT) and coagulation index, as well as postoperative Hb, HCT, coagulation index on the 3^rd day and Harris hip function score in the 6th month. The following discrete variables were analyzed by Chi-square test: gender, disease types, transfusion cases.

Results

There was no significant difference in age(t=0.657, P>0.05), gender(χ²=0.068, P>0.05), BMI(t=1.026, P>0.05), disease types(χ²=0.383, P>0.05) or operation time(t=0.193, P>0.05)between the two groups. The total blood loss(t=16.876, P<0.05), drainage volume(t=15.203, P<0.05), transfusion cases(χ²=6.032, P<0.05) in the experimental group were significantly less than those in the control group, the differences were statistically significant ; the postoperative Hb (t=4.874, P<0.05)and HCT(t=5.768, P<0.05)of the experimental group were significantly higher than those of the control group on the 3^rd day. The postoperative hrombosis events didn’t occur in the two groups.

Conclusion

Combined application of tranexamic acid and rivaroxaban in the primary THA of elderly patients does not affect the blood coagulation system, which can reduce the risk of postoperative thrombosis and the blood loss.

Key words: Arthroplasty, replacement, hip, Rivaroxaban, Tranexamic acid, Venous thrombosis, Blood loss, surgical

Xingjing Wu, Kunzheng Wang, Lihong Fan, Zhengyu Wang, Zhoushan Tao, Jiabing Xie, Guozheng Ding, Zhujun Xu. Clinical efficacy of rivaroxaban combined with topical application of tranexamic acid in primary total hip arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(03): 300-304.

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Figures/Tables 3

References 18

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组别	例数	术前Hb(g/L)	术后3 d Hb(g/L)	术前HCT(%)	术后3 d HCT(%)
实验组	73	135.4±8.9	89.3±6.4	39.4±3.8	32. 4±2.3
对照组	73	136.4±7.5	81.8±10.7	40.7±3.3	27. 1± 2.4
t值	?	0.287	4.874	0.386	5.768
P值	?	>0.05	<0.05	>0.05	<0.05

组别	例数	术前Hb(g/L)	术后3 d Hb(g/L)	术前HCT(%)	术后3 d HCT(%)
实验组	73	135.4±8.9	89.3±6.4	39.4±3.8	32. 4±2.3
对照组	73	136.4±7.5	81.8±10.7	40.7±3.3	27. 1± 2.4
t值	?	0.287	4.874	0.386	5.768
P值	?	>0.05	<0.05	>0.05	<0.05

组别	例数	纤维蛋白原(g/L)		凝血酶原时间(s)		D－二聚体(s)
组别	例数	术前	术后3 d	术前	术后3 d	术前	术后3 d
实验组	73	3.95±0.73	3.73±0.57	11.47±0.58	12.04±0.28	0.35 ±0.02	0.37±0.04
对照组	73	3.87±0.64	3.64±0.92	10.55±2.47	11.35±3.41	0.34 ±0.06	0.36±0.07
t值	?	0.876	1.037	1.082	0.985	0.201	0.413
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	纤维蛋白原(g/L)		凝血酶原时间(s)		D－二聚体(s)
组别	例数	术前	术后3 d	术前	术后3 d	术前	术后3 d
实验组	73	3.95±0.73	3.73±0.57	11.47±0.58	12.04±0.28	0.35 ±0.02	0.37±0.04
对照组	73	3.87±0.64	3.64±0.92	10.55±2.47	11.35±3.41	0.34 ±0.06	0.36±0.07
t值	?	0.876	1.037	1.082	0.985	0.201	0.413
P值	?	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	总失血量[ml, (±s)]	术中出血量[ml，(±s)]	引流量[ml，(±s)]	输血例数[例，(%)]	Harris评分(±s)
实验组	73	767±37	465±65	384±90	12(16)	81±4
对照组	73	1217±49	470±49	780±77	30(41)	80±8
统计值	?	t＝16.876	t＝0.317	t＝15.203	χ²＝6.032	t＝1.635
P值	?	<0.05	>0.05	<0.05	<0.05	>0.05

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