Comparison of Clinical Results in Deep Vein Thrombosis of Total Knee Arthroplasty with Rivaroxaban and Dalteparin Sodium
Affiliation(s)
Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Korea.
Joint & Arthritis Research, Department of Orthopaedic Surgery, Himchan Hospital, Seoul, Korea.
ABSTRACT
This study was intended to investigate into the incidence rates of deep vein thrombosis (DVT) in patients who used prophylactic antithrombotic medications after total knee arthroplasty (TKA), and to compare clinical results in groups treated with Rivaroxaban versus Dalteparin sodium as prophylactic antithrombotic medications. This prospective study was performed in 300 patients who underwent TKA between November 2011 and December 2012. The prophylactic therapy was given to 150 patients in Rivaroxaban group and Dalteparin sodium group, respectively. In addition, intermittent compression pump and stocking were used in all the groups immediately after TKA. In order to determine the incidence of DVT, color Doppler ultrasonography, D-dimer, and clinical symptom examination were conducted. There were 17 cases (11.3%) of DVT in Rivaroxaban group and 18 cases (12.0%) of DVT in Dalteparin sodium group after TKA, and no significant difference was seen between both groups. Between patients with DVT and those without DVT after TKA at 4 days in both groups, there was a significant difference in the swelling indices. Moreover, a significant difference was observed in the evaluation of bruise. The early signs of DVT after TKA are unknown, however, some initial clinical signs such as swelling have been observed. After using the said prophylactic drugs, the lower incidence of DVT was seen, and there was no difference between the types of drugs. Pharmacological therapy (either Rivaroxaban or Dalteparin sodium) after TKA is considered effective for DVT prevention. There is also a need to consider constant monitoring of clinical symptoms.
This study was intended to investigate into the incidence rates of deep vein thrombosis (DVT) in patients who used prophylactic antithrombotic medications after total knee arthroplasty (TKA), and to compare clinical results in groups treated with Rivaroxaban versus Dalteparin sodium as prophylactic antithrombotic medications. This prospective study was performed in 300 patients who underwent TKA between November 2011 and December 2012. The prophylactic therapy was given to 150 patients in Rivaroxaban group and Dalteparin sodium group, respectively. In addition, intermittent compression pump and stocking were used in all the groups immediately after TKA. In order to determine the incidence of DVT, color Doppler ultrasonography, D-dimer, and clinical symptom examination were conducted. There were 17 cases (11.3%) of DVT in Rivaroxaban group and 18 cases (12.0%) of DVT in Dalteparin sodium group after TKA, and no significant difference was seen between both groups. Between patients with DVT and those without DVT after TKA at 4 days in both groups, there was a significant difference in the swelling indices. Moreover, a significant difference was observed in the evaluation of bruise. The early signs of DVT after TKA are unknown, however, some initial clinical signs such as swelling have been observed. After using the said prophylactic drugs, the lower incidence of DVT was seen, and there was no difference between the types of drugs. Pharmacological therapy (either Rivaroxaban or Dalteparin sodium) after TKA is considered effective for DVT prevention. There is also a need to consider constant monitoring of clinical symptoms.
Cite this paper
Lee, S. , Nam, C. , Ahn, H. , Hwang, S. , Ahn, N. and Park, H. (2015) Comparison of Clinical Results in Deep Vein Thrombosis of Total Knee Arthroplasty with Rivaroxaban and Dalteparin Sodium. Open Journal of Orthopedics, 5, 17-24. doi: 10.4236/ojo.2015.52003.
Lee, S. , Nam, C. , Ahn, H. , Hwang, S. , Ahn, N. and Park, H. (2015) Comparison of Clinical Results in Deep Vein Thrombosis of Total Knee Arthroplasty with Rivaroxaban and Dalteparin Sodium. Open Journal of Orthopedics, 5, 17-24. doi: 10.4236/ojo.2015.52003.
References
[1] Lieberman, J.R. and Geerts, W.H. (1994) Prevention of Venous Thromboembolism after Total Hip and Knee Arthroplasty. Journal of Bone and Joint Surgery (America), 76, 1239-1250.
http://jbjs.org/content/76/8/1239.long [2] Geerts, W.H., Bergqvist, D., Pineo, G.F., Heit, J.A., Samama, C.M., Lassen, M.R. and Colwell, C.W., American College of Chest Physicians (2008) Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 133, 381S-453S. [3] Arcelus, J.I., Kudrna, J.C. and Caprini, J.A. (2006) Venous Thromboembolism Following Major Orthopedic Surgery: What Is the Risk after Discharge? Orthopedics, 29, 506-516.
http://dx.doi.org/10.1080/028418501127346846 [4] Kim, Y.H. and Kim, J.S. (2002) Incidence and Natural History of Deep-Vein Thrombosis after Total Knee Arthroplasty. A Prospective, Randomised Study. Journal of Bone and Joint Surgery (British), 84, 566-570.
http://dx.doi.org/10.1302/0301-620X.84B4.12330 [5] Little, J.W. (2012) New Oral Anticoagulants: Will They Replace Warfarin? Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 113, 575-580.
http://dx.doi.org/10.1016/j.oooo.2011.10.006 [6] Agnelli, G. (2004) Prevention of Venous Thromboembolism in Surgical Patients. Circulation, 110, IV4-IV12.
http://dx.doi.org/10.1161/01.CIR.0000150639.98514.6c [7] Duggan, S.T., Scott, L.J. and Plosker, G.L. (2009) Rivaroxaban: A Review of Its Use for the Prevention of Venous Thromboembolism after Total Hip or Knee Replacement Surgery. Drugs, 69, 1829-1851.
http://dx.doi.org/10.2165/11200890-000000000-00000 [8] Patel, M.R., Mahaffey, K.W., Garg, J., Pan, G., Singer, D.E., Hacke, W., Breithardt, G., Halperin, J.L., Hankey, G.J., Piccini, J.P., Becker, R.C., Nessel, C.C., Paolini, J.F., Berkowitz, S.D., Fox, K.A. and Califf, R.M., ROCKET AF Investigators (2011) Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. The New England Journal of Medicine, 365, 883-891.
http://dx.doi.org/10.1056/NEJMoa1009638 [9] Mavrakanas, T. and Bounameaux, H. (2011) The Potential Role of New Oral Anticoagulants in the Prevention and Treatment of Thromboembolism. Pharmacology & Therapeutics, 130, 46-58.
http://dx.doi.org/10.1016/j.pharmthera.2010.12.007 [10] Pfizer Medical Information (2012) Fragmin (Dalteparin Sodium) Abbreviated Prescribing Information All Presentations and Indications. Pfizer Inc.
http://www.medisis.com/client_docs/fragmin/fragmin_pi.pdf [11] Levine, M., Gent, M., Hirsh, J., Leclerc, J., Anderson, D., Weitz, J., Ginsberg, J., Turpie, A.G., Demers, C. and Kovacs, M. (1996) A Comparison of Low-Molecular-Weight Heparin Administered Primarily at Home with Unfractionated Heparin Administered in the Hospital for Proximal Deep-Vein Thrombosis. The New England Journal of Medicine, 334, 677-681.
http://dx.doi.org/10.1056/NEJM199603143341101 [12] Song, E.K., Seon, J.K., Park, S.J., Cho, S.B. and Choi, M.S. (2008) Diagnosis of the Deep Vein Thrombosis with Multidetector-Row Computed Tomographic Venography after Total Knee Arthroplasty. The Journal of the Korean Orthopaedic Association, 43, 294-300.
http://dx.doi.org/10.4055/jkoa.2008.43.3.294 [13] Warwick, D., Harrison, J., Glew, D., Mitchelmore, A., Peters, T.J. and Donovan, J. (1998) 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 and Joint Surgery—American Volume, 80, 1158-1166. [14] Lee, J.K, Chun, K.S., Baek, S.W. and Choi, C.H. (2012) The Prophylaxis of Venous Thromboembolism in Korean Patients with Total Knee Replacement Arthroplasty. The Journal of the Korean Orthopaedic Association, 47, 86-95.
http://dx.doi.org/10.4055/jkoa.2012.47.2.86 [15] Kim, Y.H. and Suh, J.S. (1988) Low Incidence of Deep-Vein Thrombosis after Cementless Total Hip Replacement. Journal of Bone and Joint Surgery—American Volume, 70, 878-882. [16] Sharrock, N.E., Haas, S.B., Hargett, M.J., Urquhart, B., Insall, J.N. and Scuderi, G. (1991) Effects of Epidural Anesthesia on the Incidence of Deep-Vein Thrombosis after Total Knee Arthroplasty. Journal of Bone and Joint Surgery—American Volume, 73, 502-506. [17] Carpenter, J.P., Holland, G.A., Baum, R.A., Owen, R.S., Carpenter, J.T. and Cope, C. (1993) Magnetic Resonance Venography for the Detection of Deep Venous Thrombosis: Comparison with Contrast Venography and Duplex Doppler Ultrasonography. Journal of Vascular Surgery, 18, 734-741.
http://dx.doi.org/10.1016/0741-5214(93)90325-G [18] Dahl, O.E., Gudmundsen, T.E. and Haukeland, L. (2000) Late Occurring Clinical Deep Vein Thrombosis in Joint-Operated Patients. Acta Orthopaedica, 71, 47-50.
http://dx.doi.org/10.1080/00016470052943883 [19] Douketis, J.D., Eikelboom, J.W., Quinlan, D.J., Willan, A.R. and Crowther, M.A. (2002) 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, 162, 1465-1471.
http://dx.doi.org/10.1001/archinte.162.13.1465
[1] Lieberman, J.R. and Geerts, W.H. (1994) Prevention of Venous Thromboembolism after Total Hip and Knee Arthroplasty. Journal of Bone and Joint Surgery (America), 76, 1239-1250.
http://jbjs.org/content/76/8/1239.long [2] Geerts, W.H., Bergqvist, D., Pineo, G.F., Heit, J.A., Samama, C.M., Lassen, M.R. and Colwell, C.W., American College of Chest Physicians (2008) Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 133, 381S-453S. [3] Arcelus, J.I., Kudrna, J.C. and Caprini, J.A. (2006) Venous Thromboembolism Following Major Orthopedic Surgery: What Is the Risk after Discharge? Orthopedics, 29, 506-516.
http://dx.doi.org/10.1080/028418501127346846 [4] Kim, Y.H. and Kim, J.S. (2002) Incidence and Natural History of Deep-Vein Thrombosis after Total Knee Arthroplasty. A Prospective, Randomised Study. Journal of Bone and Joint Surgery (British), 84, 566-570.
http://dx.doi.org/10.1302/0301-620X.84B4.12330 [5] Little, J.W. (2012) New Oral Anticoagulants: Will They Replace Warfarin? Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, 113, 575-580.
http://dx.doi.org/10.1016/j.oooo.2011.10.006 [6] Agnelli, G. (2004) Prevention of Venous Thromboembolism in Surgical Patients. Circulation, 110, IV4-IV12.
http://dx.doi.org/10.1161/01.CIR.0000150639.98514.6c [7] Duggan, S.T., Scott, L.J. and Plosker, G.L. (2009) Rivaroxaban: A Review of Its Use for the Prevention of Venous Thromboembolism after Total Hip or Knee Replacement Surgery. Drugs, 69, 1829-1851.
http://dx.doi.org/10.2165/11200890-000000000-00000 [8] Patel, M.R., Mahaffey, K.W., Garg, J., Pan, G., Singer, D.E., Hacke, W., Breithardt, G., Halperin, J.L., Hankey, G.J., Piccini, J.P., Becker, R.C., Nessel, C.C., Paolini, J.F., Berkowitz, S.D., Fox, K.A. and Califf, R.M., ROCKET AF Investigators (2011) Rivaroxaban versus Warfarin in Nonvalvular Atrial Fibrillation. The New England Journal of Medicine, 365, 883-891.
http://dx.doi.org/10.1056/NEJMoa1009638 [9] Mavrakanas, T. and Bounameaux, H. (2011) The Potential Role of New Oral Anticoagulants in the Prevention and Treatment of Thromboembolism. Pharmacology & Therapeutics, 130, 46-58.
http://dx.doi.org/10.1016/j.pharmthera.2010.12.007 [10] Pfizer Medical Information (2012) Fragmin (Dalteparin Sodium) Abbreviated Prescribing Information All Presentations and Indications. Pfizer Inc.
http://www.medisis.com/client_docs/fragmin/fragmin_pi.pdf [11] Levine, M., Gent, M., Hirsh, J., Leclerc, J., Anderson, D., Weitz, J., Ginsberg, J., Turpie, A.G., Demers, C. and Kovacs, M. (1996) A Comparison of Low-Molecular-Weight Heparin Administered Primarily at Home with Unfractionated Heparin Administered in the Hospital for Proximal Deep-Vein Thrombosis. The New England Journal of Medicine, 334, 677-681.
http://dx.doi.org/10.1056/NEJM199603143341101 [12] Song, E.K., Seon, J.K., Park, S.J., Cho, S.B. and Choi, M.S. (2008) Diagnosis of the Deep Vein Thrombosis with Multidetector-Row Computed Tomographic Venography after Total Knee Arthroplasty. The Journal of the Korean Orthopaedic Association, 43, 294-300.
http://dx.doi.org/10.4055/jkoa.2008.43.3.294 [13] Warwick, D., Harrison, J., Glew, D., Mitchelmore, A., Peters, T.J. and Donovan, J. (1998) 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 and Joint Surgery—American Volume, 80, 1158-1166. [14] Lee, J.K, Chun, K.S., Baek, S.W. and Choi, C.H. (2012) The Prophylaxis of Venous Thromboembolism in Korean Patients with Total Knee Replacement Arthroplasty. The Journal of the Korean Orthopaedic Association, 47, 86-95.
http://dx.doi.org/10.4055/jkoa.2012.47.2.86 [15] Kim, Y.H. and Suh, J.S. (1988) Low Incidence of Deep-Vein Thrombosis after Cementless Total Hip Replacement. Journal of Bone and Joint Surgery—American Volume, 70, 878-882. [16] Sharrock, N.E., Haas, S.B., Hargett, M.J., Urquhart, B., Insall, J.N. and Scuderi, G. (1991) Effects of Epidural Anesthesia on the Incidence of Deep-Vein Thrombosis after Total Knee Arthroplasty. Journal of Bone and Joint Surgery—American Volume, 73, 502-506. [17] Carpenter, J.P., Holland, G.A., Baum, R.A., Owen, R.S., Carpenter, J.T. and Cope, C. (1993) Magnetic Resonance Venography for the Detection of Deep Venous Thrombosis: Comparison with Contrast Venography and Duplex Doppler Ultrasonography. Journal of Vascular Surgery, 18, 734-741.
http://dx.doi.org/10.1016/0741-5214(93)90325-G [18] Dahl, O.E., Gudmundsen, T.E. and Haukeland, L. (2000) Late Occurring Clinical Deep Vein Thrombosis in Joint-Operated Patients. Acta Orthopaedica, 71, 47-50.
http://dx.doi.org/10.1080/00016470052943883 [19] Douketis, J.D., Eikelboom, J.W., Quinlan, D.J., Willan, A.R. and Crowther, M.A. (2002) 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, 162, 1465-1471.
http://dx.doi.org/10.1001/archinte.162.13.1465