Back
 OJO  Vol.3 No.1 , March 2013
The Clinical Characteristics of Combined Deep Vein Thrombosis Prophylaxis of Rivaroxaban and Mechanical Therapy after Total Knee Replacement Arthroplasty
Abstract: Purpose: To investigate the clinical characteristics of combined prophylaxis of rivaroxaban (Xarelto?) and mechanical therapy (foot sole pump, antiembolism stocking) after total knee replacement arthroplasty, for prevention of deep vein thrombosis (DVT). Materials and Methods: The subjects of this study were 110 patients who underwent total knee replacement arthroplasty (TKA) between November 2011 and May 2012, and were prospectively evaluated. They consisted of 13 men (11.8%) and 97 women (88.2%) with the mean age of 68.7 years (±7.9). All of the patients received 10 mg of rivaroxaban once daily for 14 days from Day 1 postoperatively, and used an intermittent pneumatic compression (IPC) pump and compression stockings immediately after the operation. To determine the presence of postoperative DVT, clinical symptoms examination, D-dimer test, color Doppler ultrasound imaging were performed to analyze the risk factors of DVT events. Results: There were a total of 13 patients (11.8%) with DVT in the distal lower limbs among the entire 110 patients. At Day 4 after the operation, a statistically significant difference was seen only in femoral swelling of several clinical symptoms between DVT group and non-DVT group (p = 0.043). D-dimer tests showed no statistically significant difference between the two groups, however with the boundary value of 0.3 mg/L, diagnostic sensitivity, specificity, positive predictability and negative predictability were equivalent to 100%, 8.2%, 12.7% and 100%, respectively. There was no significant difference between the two groups in terms of well-known risk factors including age, gender, obesity, hypertension, diabetes, smoking, and anesthesia method, and no case of pulmonary embolism was observed. Conclusion: A combination of pharmacological therapy (rivaroxaban, Xarelto?) and mechanical therapy (foot sole pump system) after TKA is considered effective for DVT prevention.
Cite this paper: S. Lee, C. Nam, H. Ahn, B. Hwang, J. Kim and H. Park, "The Clinical Characteristics of Combined Deep Vein Thrombosis Prophylaxis of Rivaroxaban and Mechanical Therapy after Total Knee Replacement Arthroplasty," Open Journal of Orthopedics, Vol. 3 No. 1, 2013, pp. 14-19. doi: 10.4236/ojo.2013.31004.
References

[1]   D. L. Riddle, F. J. Keefe, D. Ang, K. J. Saleh, L. Dumenci, M. P. Jensen, M. J. Bair, S. D. Reed and K. Kroenke, “A Phase III Randomized Three-Arm Trial of Physical Therapist Delivered Pain Coping Skills Training for Patients with Total Knee Arthroplasty: The Kastpain Protocol,” BMC Musculoskeletal Disorders, Vol. 13, No. 1, 2012, pp. 1239-1250. doi:10.1186/1471-2474-13-149

[2]   J. R. Lieberman and W. H. Geerts, “Prevention of Venous Thromboembolism after Total Hip and Knee Arthroplasty,” Journal of Bone & Joint Surgery, Vol. 76, No. 8, 1994, pp. 1239-1250. doi:10.2106/JBJS.D.03033

[3]   W. H Geerts, D. Bergqvist, G. F. Pineo, J. A. Heit, C. M. Samama, M. R. Lassen and C. W. Colwell, “Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition),” Chest, Vol. 133, No. 6, 2008, pp. 381S453S. doi:10.1378/chest.08-0656

[4]   Y. H. Kim and J. S. Kim, “Incidence and Natural History of Deep-Vein Thrombosis after Total Knee Arthroplasty. A Prospective, Randomised Study,” The Bone & Joint Journal, Vol. 84, No. 4, 2002, pp. 566-570. doi:10.1302/0301-620X.84B4.12330

[5]   D. S. Hwang, S. T. Kwon, Y. M. Kim, Y. J. Young, S. H. Yune and H. C. Jeong, “Prophylaxis of Postoperative Deep Vein Thrombosis and Thromboembolism with Low Molecular Weight Heparin (Nadroparin Calcium) after Hip Arthroplasty—Comparison with Warfarin and Low Molecular Weight Dextran,” Journal of the Korean Orthopedic Association, Vol. 34, No. 1, 1999, pp. 9-16.

[6]   J. I. Arcelus, J. C. Kudrna and J. A. Caprini, “Venous Thromboembolism Following Major Orthopedic Surgery: What Is the Risk after Discharge?” Orthopedics, Vol. 29, No. 6, 2006, pp. 506-516.

[7]   J. W. Little, “New Oral Anticoagulants: Will They Replace Warfarin?” Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, Vol. 113, No. 5, 2012, pp. 575580. doi:10.1016/j.oooo.2011.10.006

[8]   G. Agnelli, “Prevention of Venous Thromboembolism in Surgical Patients,” Circulation, Vol. 110, No. 4, 2004, pp. 4-12. doi:10.1161/01.CIR.0000150639.98514.6c

[9]   S. T. Duggan, L. J. Scott and G. L. Plosker, “Rivaroxaban: A Review of Its Use for the Prevention of Venous Thromboembolism after Total Hip or Knee Replacement Surgery,” Drugs, Vol. 69, No. 13, 2009, pp. 1829-1851. doi:10.2165/11200890-000000000-00000

[10]   R. P. Manesh, W. M. Kenneth, G. Jyotsna, P. Guohua, E. S. Daniel, H. Werner, B. Günter, L. H. Jonathan, J. H. Graeme, P. P. Jonathan, C. B. Richard, C. N. Christopher, F. P. John, D. B. Scott, A. A. F. Keith, Ch.B. and M. C. Robert, “Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation,” Indian Heart J, Vol. 64, No. 1, 2012, pp. 110-111. doi:10.1016/S0019-4832(12)60029-7 http://www.sciencedirect.com/science/article/pii/S0019483212600297

[11]   E. K. Song, J. K. Seon, S. J. Park, S. B. Cho and M. S. Choi, “Diagnosis of the Deep Vein Thrombosis with Multidetector-Row Computed Tomographic Venography after Total Knee Arthroplasty,” Journal of the Korean Orthopedic Association, Vol. 43, No. 3, 2008, pp. 294-300.

[12]   D. Warwick, J. Harrison, D. Glew, A. Mitchelmore, T. J. Peters and J. Donovan, “Comparison of the Use of a Foot Pump with the Use of Low-Molecular-Weight Heparin for the Prevention of Deep-Vein Thrombosis after Total Hip Replacement. A Prospective, Randomized Trial,” Journal of Bone & Joint Surgery, Vol. 80, No. 8, 1998, pp. 1158-1166.

[13]   J. K. Lee, K. S. Chun, S. W. Baek and C. H. Choi, “The Prophylaxis of Venous Thromboembolism in Korean Patients with Total Knee Replacement Arthroplasty,” Journal of the Korean Orthopedic Association, Vol. 47, No. 2, 2012, pp. 86-95.

[14]   P. Frosch, J. Decking, C. Theis, P. Drees, C. Schoellner and A. Eckardt, “Complications after Total Knee Arthroplasty: A Comprehensive Report,” Acta Orthopaedica Belgica, Vol. 70, No. 6, 2004, pp. 565-569.

[15]   Y. J. Kim, C. I. Hur, E. K. Song, J. K. Seon, S. J. Park, S. B. Cho and Y. J. Cho, “Availability of D-Dimer Test for the Diagnosis of Deep Vein Thrombosis after Total Knee Arthroplasty,” Journal of the Korean Orthopedic Association, Vol. 42, No. 4, 2007, pp. 523-529.

[16]   S. N. Melillo, J. V. Scanlon, B. P. Exter, M. Steinberg and C. I. Jarvis, “Rivaroxaban for Throm-boprophylaxis in Patients Undergoing Major Orthopedic Surgery,” The Annals of Pharmacotherapy, Vol. 44, No. 6, 2010, pp. 1061-1071. doi:10.1345/aph.1M681

[17]   Intermountain Joint Replacement Center Writing Committee, “A Prospective Comparison of Warfarin to Aspirin for Thromboprophylaxis in Total Hip and Total Knee Arthroplasty,” The Journal of Arthroplasty, Vol. 27, No. 1, 2012, pp. 1-9. doi:10.1016/j.arth.2011.03.032

[18]   P. T. Duncan, “Venous Trombogenesis,” Annual Review of Medicine, Vol. 36, 1985, pp. 39-50. doi:10.1146/annurev.me.36.020185.000351

[19]   D. S. Hwang, S. T. Kwon, S. H. Yune, H. R. Oh and S. Y. Lee, “Deep Venous Thrombosis after Hip Arthroplasty,” Journal of the Korean Orthopedic Association, Vol. 32, No. 3, 1997, pp. 554-564.

[20]   S. Bredbacka, M. Andreen, M. Blombäck and A. Wykman, “Activation of Cascade Systems by Hip Arthroplasty. No Difference between Fixation with and without cement,” Acta Orthopaedica Scandinavica, Vol. 53, No. 3, 1987, pp. 231-235.

[21]   Y. H. Kim and J. S. Suh, “Low Incidence of Deep-Vein Thrombosis after Cementless Total Hip Replacement,” Journal of Bone & Joint Surgery, Vol. 70, No. 6, 1988, pp. 878-882.

[22]   N. E. Sharrock, S. B. Haas, M. J. Hargett, B. Urquhart, J. N. Insall and G. Scuderi, “Effects of Epidural Anesthesia on the Incidence of Deep-Vein Thrombosis after Total Knee Arthroplasty,” Journal of Bone & Joint Surgery, Vol. 73, No. 4, 1991, pp. 502-506.

[23]   J. P. Carpenter, G. A. Holland, R. A. Baum, R. S. Owen, J. T. Carpenter and C. Cope, “Magnetic Resonance Venography for the Detection of Deep Venous Thrombosis: Comparison with Contrast Venography and Duplex Doppler Ultrasonography,” Journal of Vascular Surgery, Vol. 18, No. 5, 1993, pp. 734-741. doi:10.1016/0741-5214(93)90325-G

[24]   O. E. Dahl, T. E. Gudmundsen and L. Haukeland, “Late Occurring Clinical Deep Vein Thrombosis in Joint-Operated Patients,” Acta Orthopaedica Scandinavica, Vol. 71, No. 1, 2000, pp. 47-50. doi:10.1080/00016470052943883

[25]   J. D. Douketis, J. W. Eikelboom, D. J. Quinlan, A. R. Willan and M. A. Crowther, “Short-Duration Prophylaxis against Venous Thromboembolism after Total Hip or Knee Replacement: A Meta-Analysis of Prospective Studies Investigating Symptomatic Outcomes,” Archives of Internal Medicine, Vol. 162, No. 13, 2002, pp. 14651471.

 
 
Top