The Efficacy of Combined Use of Rivaroxaban and Tranexamic Acid on Blood Conservation in Minimally Invasive Total Knee Arthroplasty a Double-Blind Randomized, Controlled Trial

Wang, Junwen; Chen, Bradley; Lin, Po‐Chun; Yen, Shih-Hsiang; Huang, Chao‐Cheng; Kuo, Feng-Chih

doi:10.1016/j.arth.2016.08.020

Cited by 26 publications

(17 citation statements)

References 45 publications

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“…However, rivaroxaban has been associated with complications related to bleeding due to its potent anticoagulant properties. Wang et al [ 21 ] demonstrated that in patients given rivaroxaban alone after TKA, compared to patients with additional intravenous TXA, significantly higher incidences of ecchymoses and wound hematoma were recorded. Ricket et al [ 14 ] compared patients who received either rivaroxaban or enoxaparin and described a higher rate of clinically relevant non-major bleeding, including surgical site bleeding and hematoma.…”

Section: Discussionmentioning

confidence: 99%

Combined use of topical intraarticular tranexamic acid and rivaroxaban in total knee arthroplasty safely reduces blood loss, transfusion rates, and wound complications without increasing the risk of thrombosis

Kim

Kang

Lee

et al. 2018

BMC Musculoskelet Disord

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BackgroundBlood loss and deep vein thrombosis (DVT) are important complications after total knee arthroplasty (TKA). Topical tranexamic acid (TXA) effectively reduces wound bleeding but may elevate the risk of DVT. In contrast, rivaroxaban potently prevents DVT but has been associated with bleeding complications. The simultaneous use of topical TXA and rivaroxaban in TKA has not been much investigated.MethodsA retrospective cohort study was conducted with two consecutive groups of patients who underwent TKA. Intraoperatively, one group (RVTX group) received topical, intraarticular TXA, while the other (RV group) did not. Both groups were administered rivaroxaban postoperatively for 14 days and underwent Doppler ultrasound for DVT screening. After propensity score matching, both groups consisted of 52 patients (104 patients in total) and were compared regarding total drain output, nadir haemoglobin (Hb), maximum Hb decrease, calculated total blood loss, transfusion rate, and incidence of DVT and wound complications.ResultsBoth groups showed no significant differences in the propensity-matched variables of age, sex, body mass index, American Society of Anesthesiologists physical status score, and preoperative Hb. The RVTX group showed a significantly higher nadir Hb (p < 0.001), lower drain output (p < 0.001), Hb decrease (p = 0.015), total blood loss (p < 0.001), and rate of transfusion (p < 0.001) and fewer wound complications (p = 0.027). However, the incidence of DVT (p = 1.000) did not differ significantly between the two groups, and all cases were asymptomatic.ConclusionsThe combined use of intraarticular topical TXA with rivaroxaban in patients undergoing TKA is a safe and effective method to reduce blood loss, the need for transfusion, and wound complications without elevating the risk of DVT.

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Section: Discussionmentioning

confidence: 99%

Combined use of topical intraarticular tranexamic acid and rivaroxaban in total knee arthroplasty safely reduces blood loss, transfusion rates, and wound complications without increasing the risk of thrombosis

Kim

Kang

Lee

et al. 2018

BMC Musculoskelet Disord

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“…Most of external blood loss occurs within the first 24 hours postoperatively following optimization of surgical hemostasis when fewer tourniquets are used, whereas topical TXA concurrently reduces transfusion amounts and transfusion-related complications. Wang et al 38 showed that in patients administered rivaroxaban alone after TKA, compared with patients with additional intravenous TXA, significantly higher incidences of ecchymosis and wound hematoma were recorded. The antifibrinolytic agent TXA does not trigger a coagulation cascade; instead, it exerts hemostatic effect by inhibiting degradation of fibrin already formed at the bleeding foci.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Bilateral Total Knee Arthroplasty Becomes Safer after Institution of Optimal Perioperative Management: A Longitudinal Cohort Study

Chen

Wong

et al. 2020

J Knee Surg

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Simultaneous bilateral total knee arthroplasty (SBTKA) increases the rates of procedure-related complications and mortality compared with unilateral TKA. There are no well-defined guidelines for selecting patients to avoid mortality and proposing an upgrade treatment to decrease complication rates. This study aimed to evaluate whether optimal perioperative management could improve the safety of SBTKA. From 2005 to 2017, 1,166 cases of SBTKA were identified from 14,209 TKA procedures. We retrospectively examined the SBTKA patients' demographics, comorbidity profiles, procedure-related complications, and perioperative management during two time periods. Optimal perioperative workup for managing SBTKA significantly decreased the incidences of major complication from 6.2 to 2.4% (p = 0.001) and minor complications from 28.9 to 21.5% (p = 0.004) during period I and period II, respectively. The efficiency of less tourniquet use along with intraarticular tranexamic acid injection was demonstrated by the decreases of hemoglobin (Hb) change in the first 2 days after surgery (p = 0.005) and blood transfusion requirement (p = 0.035) during the SBTKA. Furthermore, the less tourniquet use group had less thigh pain (visual analog scale decreased from 6.0 to 4.2, p = 0.003), shorter duration of hospital stay (decreased from 7.8 to 7.1, p < 0.001), and lower coagulation time (decrease from 3.5 to 2.9, p < 0.001) than the routine tourniquet use group. Patient's screening must be performed carefully for cardiopulmonary compromise in patients aged >80 years and with an American Society of Anesthesiologists score of 3. Additionally, hospitalists should consider developing methods for the eligibility, testing, and perioperative monitoring of patients who undergo SBTKA with the aim of avoiding complications and improving outcomes.

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“…When evaluating the primary endpoints, we found that the results were highly heterogeneous, so we did sensitivity analyses to decompose it. The results showed that after excluding Wu et al 's article [30], the overall effect of TBL has been greatly affected; after excluding Wang et al 's article [18], the overall effect of NMB has been greatly affected; the heterogeneity of BTV cannot be explore by sensitivity analysis, which may be caused by the lack of studies. In the study of Wu et al [46], the TBL was calculated according to the formula provided by Good et al [47], which was somewhat different from the calculation methods in other studies.…”

Section: Discussionmentioning

confidence: 99%

“…Then, we further eliminated the unfit studies by reading the full text of the articles. Finally, 16 studies [12,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] (23 trial comparisons) were included according to the inclusion and exclusion criteria and they had a total of 2179 patients as shown in Fig. 1.…”

Section: Studies Retrieved and Characteristicsmentioning

confidence: 99%

The Efficacy and Safety of Tranexamic Acid Combined with Rivaroxaban in Prevention of Clinical Events in Patients after Total Knee/ Hip Arthroplasty: A Meta-analysis

Bo¹,

Jiang²,

Deng³

et al. 2020

Preprint

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Purpose To evaluate the efficacy and safety of tranexamic acid combined with rivaroxaban in prevention of clinical events in patients after TKA/THA through meta-analysis of randomized controlled trials. Materials and Methods RCTs were retrieved from medical literature databases. RR, SMD and 95% confidence intervals (CI) were calculated to compare the primary and safety endpoints. Results In total, 16 articles (23 trial comparisons) were retrieved which contained 2179 patients. In general, 1257 patients (57.7%) were randomized to experimental group whereas 922 patients (42.3%) were randomized to control group. The result showed that TXA combined with rivaroxaban significantly reduce TBL, BTV, BTR and the incidence of MB compared to the control group; there were no significant differences in NMB between experimental group and control group. Conclusions This meta-analysis reveals that TXA combined with rivaroxaban can significantly reduce TBL, BTV, the incidence of blood transfusion and the incidence of MB compared to the control group, which proved that its efficacy and safety are trustworthy.

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The Efficacy of Combined Use of Rivaroxaban and Tranexamic Acid on Blood Conservation in Minimally Invasive Total Knee Arthroplasty a Double-Blind Randomized, Controlled Trial

Cited by 26 publications

References 45 publications

Combined use of topical intraarticular tranexamic acid and rivaroxaban in total knee arthroplasty safely reduces blood loss, transfusion rates, and wound complications without increasing the risk of thrombosis

Combined use of topical intraarticular tranexamic acid and rivaroxaban in total knee arthroplasty safely reduces blood loss, transfusion rates, and wound complications without increasing the risk of thrombosis

Simultaneous Bilateral Total Knee Arthroplasty Becomes Safer after Institution of Optimal Perioperative Management: A Longitudinal Cohort Study

The Efficacy and Safety of Tranexamic Acid Combined with Rivaroxaban in Prevention of Clinical Events in Patients after Total Knee/ Hip Arthroplasty: A Meta-analysis

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