CP-055 Effect of rivaroxaban on wound healing after elective tibial osteotomy

Abstract

Background After elective tibial osteotomy patients are considered at high risk of venous thromboembolism (VTE) due to prolonged immobilisation. Routine pharmacological thromboprophylaxis for these patients is widely adopted in clinical practice despite a lack of evidence. There is no consistent agreement on the optimal agent or the duration of prophylaxis. While the newer oral anticoagulants seem to offer significant benefits compared to low molecular weight heparins (LMWH), there is still uncertainty about their safety profile, mainly bleeding rates and surgical wound complications. Purpose The aim of our study was to estimate the effect of rivaroxaban on surgical wound complications compared to the commonly used LMWH dalteparin sodium in patients after elective tibial osteotomy. Materials and methods We conducted a blinded prospective observational study between January 2012 and July 2012. Consecutive adult patients were included after elective tibial osteotomy. Patients with CLCR < 30 ml/min, liver disease Child class B or C or abnormal coagulation profile were excluded. All patients received a routine perioperative prophylactic antibiotic (1 g cefazolin IV after the induction of anaesthesia) and postoperative analgesia (15 mg piritramide IV every 6 h and paracetamol 1 g IV every 8 h). None of them had concomitant treatment. Thromboprophylaxis with was assigned to each patient included. The method of thromboprophylaxis was determined by the anaesthesiologist’s preference and consisted of either dalteparin 5000 IU SC. or rivaroxaban 10 mg p.o., beginning within 6–8 h after the surgery and continued every 24 h until full mobilisation. We monitored prolonged wound secretion and wound healing delay more than 14 days after the surgery. Results 30 patients were included in the study; 8 female and 22 male, average age 38.2 years (18–55). 22 (74%) patients were given dalteparin, to (27%) rivaroxaban. The incidence of prolonged wound secretion and wound healing delay was 4.5% (1 patient) in the dalteparin group, while 25% (2 patients) in rivaroxaban group, but the difference was not significant (p = 0.099). Conclusions Data suggest that the use of rivaroxaban for thromboprophylaxis in tibial osteotomy could be connected to higher incidence of prolonged wound discharge and wound healing compared to dalteparin. The difference was not statistically significant, maybe because of too small a number of patients included in the study. Additional studies are required to clarify the potential effect of rivaroxaban on surgical wound complications after elective tibial osteotomy. No conflict of interest.