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Analysis of Rivaroxaban on Preventing Deep Venous Thrombosis in Total Hip Arthroplasty

Author: LinNa
Tutor: KanWuSheng
School: Hubei University of Chinese Medicine
Course: TCM orthopedics and traumatology
Keywords: hidden blood loss venous thromboembolism arthroplasty heparin low-molecular-weight rivaroxaban
CLC: R687.4
Type: Master's thesis
Year: 2013
Downloads: 42
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Abstract


Objectives:The treatment of anticoagulation after Total hip arthroplasty (THA) has gained more and more attention. The use of anticoagulant drugs can prevent deep venous thrombosis of lower venous thromboembolism, but may also give rise to more blood loss during the operation. So we have this retrospectively analyzed study to evaluate the efficacy and safety of rivaroxaban in prevention of venous thromboembolism after total hip arthroplasty.Methods:From September2011to November2012, total of108patients (108hips) with the hip disease in our hospital undergoing primary total hip replacement were recruited in this study.49Male cases,59Female cases;53right hips,55left hips. Including35cases of femoral head necrosis,48cases of osteoarthritis of hip,4cases of rheumatoid arthritis,6cases of ankylosing spondylitis,15cases of old femoral neck fracture. Rivaroxaban group had54cases, male28cases, female26cases, mean age63.51±11.09years old, the average of body mass index (BMI) was24.78±3.74kg/m2, LMWH had54cases, male24cases, female30cases, mean age65.26±9.67years, an average of BMI was24.04±3.98kg/m2. There were no statistical significance in terms of differences (P>0.05) of general conditions.All operations were primary and operated by the same surgical physicians using the same surgeon. Rivaroxaban patients took oral rivaroxaban in postoperative6-10h,10mg,1time per day for2weeks; LMWH group received a subcutaneous injection of heparin0.4ml in postoperative6-10h,1time per day for2weeks; To compare the change of hemoglobin (HB),platelet (PLT), prothrombin time (PT) and activated partial thromboplastin time (APTT) at the time of pre-surgery2nd and5th day post surgery. Minor bleeding and major bleeding events measured and compared between the LMWH and rivaroxaban groups. To count the total volume of blood loss with the values of blood routine examinations taken pre-surgery and post-surgery. To calculate dominant blood loss by recording amount of blood loss in surgery, drainage and exudation after extubation. To recheck the color Doppler ultrasound of lower limbs to evaluate DVT7th day post surgery. The statistical software SPSS13.0was statistically analyzed using paired test.Results:All cases were followed up by outpatient service or telephone. There were no significant differences regarding the levels of HB、PLT、PT、APTT、minor bleeding events and major bleeding events between the2groups pre-surgery and post-surgery (P>0.05). There was no significant difference in DVT incidence between the2groups, with0%in the rivaroxaban group and3.45%in the LMWH group(P>0.05). The actual post-surgery total blood loss in Rivaroxaban group averaged1591.22±232.74ml, the hidden blood loss was548±103ml,34.46%of the total. The actual post-surgery total blood loss in LMWH group averaged1570.73±204.29ml, the hidden blood loss was463±85ml,29.51%of the total. There was no significant difference in the total blood loss and hidden blood loss (P=0.253). Conclusion:Compared with LMWH, rivaroxaban is more effective than LMWH in DVT prevention after THA. At the same time, it has the good safety, and the total and hidden blood loss does not increase after primary total hip arthroplasty.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Joint Surgery
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