Analysis of the application of Rivaroxaban after anti-fibrinolysis with Tranexamic acid in total hip arthroplasty
FAN Yanan1 WEN Yangyang1 LI Wenlong2 ZHU Yingjie2 LIU Youwen2
1.Department of Postgraduate Education for Luoyang Working, Henan University of Chinese Medicine, Henan Province, Zhengzhou 450046, China;
2.The Second Department of Hip Injury, Henan Luoyang Orthopedic Traumatological Hospital, Orthopaedic Hospital of Henan Procince, Henan Province, Luoyang 471002, China
Abstract：Objective To evaluate the safety and efficacy of Rivaroxaban anticoagulation in the prevention of venous thromboembolism (VTE) after Tranexamic anti-fibrinolysis in total hip arthroplasty (THA) patients. Methods From March 2015 to September 2016, sixty patients with osteonecrosis of femoral head accepted THA in Henan Luoyang Orthopedic Traumatological Hospital were divided into two groups by random number table, with 30 cases in each group. The patients in group A were treated with low molecular weight heparin calcium to prevent VTE, while the patients in group B were treated with Rivaroxaban. In both groups, preoperative intravenous injection and postoperative intracavitary injection of Tranexamic acid were performed. The blood loss volume, the occurrence rates of VTE, blood transfusion and anticoagulation-related bleeding events, and blood coagulation between the two groups were recorded and compared. Results There was no significant difference in blood loss volume and transfusion rate between the two groups (P ＞ 0.05). During the follow-up, it had no symptomatic pulmonary embolism and deep venous thrombosis in the both groups, and there was no significant difference in the rate of VTE between the two groups (P ＞ 0.05). As for anticoagulant bleeding events, major bleeding events were not found in the two groups, and there was no significant difference in non-major bleeding events (P ＞ 0.05). Postoperative coagulation test showed that the prothrombin time and activated partial thromboplastin time in both groups were longer in the safety range than in the preoperative period, and there was no statistically significant difference between groups at the same time (P > 0.05). Conclusion The use of low molecular weight heparin calcium or rivaroxaban in the prevention of venous thromboembolism in patients with THA are both safe and effective. However low molecular weight heparin calcium requires subcutaneous injection and dose adjustment. In contrast，patients in Rivaroxaban are more receptive and compliant, which can be ensured that the postoperative drug prevention VTE time and improve surgical safety.
范亚楠1 温阳阳1 李文龙2 朱英杰2 刘又文2. 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[J]. 中国医药导报, 2017, 14(36): 84-88.
FAN Yanan1 WEN Yangyang1 LI Wenlong2 ZHU Yingjie2 LIU Youwen2. Analysis of the application of Rivaroxaban after anti-fibrinolysis with Tranexamic acid in total hip arthroplasty. 中国医药导报, 2017, 14(36): 84-88.
[1] 张庆，卢晓栋，富学禹，等.全髋关节置换术局部应用氨甲环酸有效性及安全性Meta分析[J].中国中西医结合外科杂志，2017，23（1）：21-25.
[2] 范亚楠，温阳阳，张蕾蕾，等.不同途径应用氨甲环酸对初次全髋关节置换术患者有效性及近期安全性研究[J].中国医药导报，2017，14（21）：97-100.
[3] Xie J，Hu Q，Qiang H，et al. Comparison of intravenous versus topical tranexamic acid in primary total hip and knee arthroplasty：an updated meta-analysis [J]. Thromb Res，2017， 153：28-36.
[4] Kayupov E，Fillingham YA，Okroj K，et al. Oral and intravenous tranexamic acid are equivalent at reducing blood loss following total hip arthroplasty：a randomized controlled trial [J]. J Bone Joint Surg Am，2017，99（5）：373.
[5] 张鹤山，李子荣.股骨头坏死诊断与治疗的专家建议[J].中华骨科杂志，2007，27（2）：146-148.
[6] Nadler SB，Hidalgo JH，Bloch T. Prediction of blood volume in normal human adults [J]. Surgery，1962，51（2）：224-232.
[7] Gross JB. Estimating allowable blood loss：corrected for dilution [J]. Anesthesiology，1983，58（3）：277.
[8] Schulman S，Angeas U，Bergqvist D，et al. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients [J]. J Thromb Haemost，2010，8（6）：1443-1444.
[9] 张维平，康两期，陈卫，等.全髋关节置换术围手术期隐性失血的研究进展[J].中医正骨，2015（8）：61-64.
[10] Bierbaum BE，Callaghan JJ，Galante JO，et al. An analysis of blood management in patients having a total hip or knee arthroplasty [J]. J Bone Joint Surg Am，1999，81（1）：2.[11] Liu X，Zhang X，Chen Y，et al. Hidden Blood Loss After Total Hip Arthroplasty [J]. J Arthroplasty，2013，26（7）：1100-1105.
[12] Chen Y，Chen Z，Cui S，et al. Topical versus systemic tranexamic acid after total knee and hip arthroplasty：a meta-analysis of randomized controlled trials [J]. Medicine（Baltimore），2016，95（41）：e4656.
[13] Chang CH，Chang Y，Chen DW，et al. Topical tranexamic acid reduces blood loss and transfusion rates associated with primary total hip arthroplasty [J]. Clin Orthop Relat Res，2014，472（5）：1552-1557.
[14] Pei Z，Yuan L，Chen P，et al. Combined application versus topical and intravenous application of tranexamic acid following primary total hip arthroplasty：a meta-analysis [J]. BMC Musculoskelet Disord，2017，18（1）：90.
[15] 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[J].中华骨科杂志，2009，29（6）：70-72.
[16] 王浩洋，康鹏德，裴福兴，等.氨甲环酸减少全髋关节置换术围手术期失血的有效性及安全性研究[J].中国骨与关节杂志，2015（8）：649-654.
[17] 岳辰，马俊，杨沛青，等.氨甲环酸减少同期双侧全髋置换围术期失血有效性及安全性研究[J].中国矫形外科杂志，2014，22（10）：865-869.
[18] 胡栢均，高大伟，林志炯.氨甲环酸和低分子肝素在髋关节置换围手术期的应用[J].青岛医药卫生，2015，47（6）：435-436.
[19] Randelli F，Biggi F，Rocca GD，et al. Italian intersociety consensus statement on antithrombotic prophylaxis in hip and knee replacement and in femoral neck fracture surgery [J]. J Orthop Traumatol，2010，24（3）：206-211.
[20] Levitan B，Yuan Z，Turpie AG，et al. Benefit-risk assessment of rivaroxaban versus enoxaparin for the prevention of venous thromboembolism after total hip or knee arthroplasty [J]. Vasc Health Risk Manag，2014，10（10）：157-167.
2017, Vol. 14 
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