Rivaroxaban is as efficient and safe as bemiparin as thromboprophylaxis in knee arthroscopy

Muñoa, L.; González, Amy Berrington de; Rada, P. Díaz de; Valentí-Azcárate, Andrés; Valentí, J.R.

doi:10.1007/s12306-013-0287-7

Cited by 14 publications

(15 citation statements)

References 30 publications

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“…Several studies have compared the rates of DVT in patients who have received DVT prophylaxis after arthroscopic knee surgery to those who did not. 21 , 22 …”

Section: Discussionmentioning

confidence: 99%

“…Ten patients (15.6%) in the control group had a DVT with no patient experiencing a PE, while 1 (1.5%) in the LMWH group and a DVT as well as a PE. Munoa et al 22 randomized 467 patients to bemiparin or rivaroxaban for VTE prophylaxis after a variety of arthroscopic knee surgeries, with no documented DVT or PE postoperatively. Wirth et al 30 evaluated 262 patients who underwent arthroscopic knee surgery who received either LMWH or nothing after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Given that there is no standard of care with regard to VTE prophylaxis after ACL reconstruction, there are some surgeons who routinely use chemical VTE prophylaxis in these patients and others who do not. 3 , 19 , 22 Use of various types of pharmacological VTE prophylaxis including coumadin, rivaroxaban, low–molecular weight heparin (LMWH), and aspirin have been reported. While these medicines are effective in decreasing the rates of VTE after knee arthroscopy and other procedures, they are not without side effects, including hemarthrosis, adverse reactions to the medication itself, and others.…”

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confidence: 99%

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Rates of Deep Venous Thrombosis and Pulmonary Embolus After Anterior Cruciate Ligament Reconstruction

et al. 2015

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Context:Venous thromboembolic (VTE) disease is thought to be an uncommon but serious problem after anterior cruciate ligament (ACL) reconstruction. Rates of VTE after ACL reconstruction are not well documented.Objective:To determine the rates of deep vein thrombosis (DVT) and symptomatic pulmonary emboli (PE) after ACL reconstruction.Data Sources:Five publicly available databases (PubMed, Cochrane Database of Systematic Reviews, Scopus, Embase, and CINAHL Complete) were utilized.Study Selection:All studies that screened patients for DVT and reported rates of DVT and PE after ACL reconstruction were eligible for inclusion. Level 5 evidence, cadaver, biomechanical, and basic science studies; studies reporting only multiligament reconstruction outcomes; studies where rates of DVT and PE could not be separated out from patients undergoing other types of arthroscopic knee procedures; and classification studies were excluded.Study Design:Systematic review.Level of Evidence:Level 4.Data Extraction:All study, subject, and surgical data were analyzed. Descriptive statistics were calculated.Results:Six studies met the inclusion criteria, with a mean Modified Colman Methodology Score of 30 ± 8.22. A total of 692 patients (488 men [70.5%]; mean age, 31.6 ± 2.82 years; mean follow-up, 7 ± 18.4 months) underwent ACL reconstruction using either semitendinosus-gracilis autograft (77.6%), bone–patellar tendon–bone (BTB) autograft (22%), or allograft (0.4%). No patient received postoperative pharmacological anticoagulation. Fifty-eight patients (8.4%) had a DVT (81% below knee and 19% above knee), while only 1 patient (0.2%) had a symptomatic PE. When reported, 27% of DVT episodes were symptomatic.Conclusion:The rate of DVT after ACL reconstruction in patients who did not receive postoperative pharmacological anticoagulation is 8.4%, while the rate of symptomatic PE is 0.2%. Of the DVT episodes that occurred, 73% were asymptomatic.

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“…Several studies have compared the rates of DVT in patients who have received DVT prophylaxis after arthroscopic knee surgery to those who did not. 21 , 22 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Rates of Deep Venous Thrombosis and Pulmonary Embolus After Anterior Cruciate Ligament Reconstruction

et al. 2015

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“…Although the incidence of venous thromboembolism is low, rivaroxaban and bemiparin thromboprophylaxis for 3 weeks after knee arthroscopy efficiently and safely prevents this complication. The orthopedic surgeon's choices for thromboprophylaxis for knee arthroplasty include none (which is associated with 6.4 adverse outcomes per 1000 knee arthroplasties), 21 treatment of all patients for 3 weeks, 26 or, as the authors suggest, treatment of patients who are at high risk as defined by thrombophilia screening.…”

Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism After Knee Arthroscopy in Undiagnosed Familial Thrombophilia

Jetty¹,

Glueck²,

Freiberg³

et al. 2016

Orthopedics

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Venous thromboembolism is uncommon after knee arthroscopy, and there are no guidelines for thromboprophylaxis in elective routine knee arthroscopy. Preoperative evaluation of common thrombophilias should provide guidance for postarthroscopy thromboprophylaxis in otherwise healthy patients who are at high risk for venous thromboembolism. This study assessed 10 patients with venous thromboembolism after total hip or knee arthroplasty. Patients were assessed if venous thromboembolism occurred within 6 months after knee arthroscopy (n=10) or total hip or knee arthroplasty (n=21). This study assessed gene mutations (factor V Leiden, prothrombin G20210A, plasminogen activator inhibitor, methylenetetrahydrofolate reductase) and serologic thrombophilias (high levels of factors VIII and XI, homocysteine, anticardiolipin immunoglobulin G and immunoglobulin M antibodies, and lupus anticoagulant; low antigenic protein C, S, and free S; and antithrombin III deficiency). The same coagulation data were obtained for normal subjects (n=110). The major thrombophilias in the arthroscopy group were factor V Leiden heterozygosity (40%), high factor VIII level (50%), and high homocysteine (30%). The respective values in control subjects were 2% (P=.0004), 7% (P=.0011), and 5% (P=.02). When the arthroscopy group was compared with the 21 patients who had venous thromboembolism after total hip or knee arthroplasty, the sole difference was factor V Leiden heterozygosity, which was 40% vs 0%, respectively (P=.007). Although venous thromboembolism after knee arthroscopy is uncommon, to identify high-risk patients and guide postoperative thromboprophylaxis, the authors suggest routine preoperative measurement of 3 common familial thrombophilias: factor V Leiden, factor VIII, and homocysteine. [Orthopedics. 2016; 39(6):e1052-e1057.].

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“…Both standard and heparinasemodified tests can be performed to increase the sensitivity of TEG/ROTEM testing, specifically geared to determine the effects of low molecular weight heparin and heparinoids on coagulation [6]. Because platelets play a key role in overall coagulation, the assessment of the platelet function, more than their number, is critical in the perioperative setting [29,30]; Munoa et al [31]. Traditional assays, such as turbidimetric platelet aggregometry, are still considered a clinical standard for platelet function testing.…”

Section: Monitoring Anticoagulationmentioning

confidence: 99%

Perioperative coagulopathy monitoring

et al. 2013

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Coagulopathy is common in orthopedic surgery patients either due to acquired factors, such as surgery, trauma, medications, or hemorrhage. Perioperative monitoring of blood coagulation is critical to diagnose the causes of hemorrhage, guide hemostatic therapies, predict the risk of bleeding during surgical procedures, and reduce risk of postoperative cardiac and thromboembolic events. In contrast to previous interventions that measure specific portions of the clotting cascade (such as intrinsic or extrinsic pathways or platelet aggregation), ''Point-ofcare'' coagulation monitoring devices assess the viscoelastic properties of whole blood. These techniques have the potential to measure the entire clotting process, starting with fibrin formation, clot retraction, and fibrinolysis. Furthermore, the coagulation status of patients is assessed in whole blood, allowing the plasmatic coagulation system to interact with platelets and red cells, and thereby providing useful additional information on platelet function. Improved monitoring of coagulopathy is particularly important as new anticoagulant drugs emerge that affect the clotting cascade in novel ways, including the inhibition of intrinsic and extrinsic pathways and platelet function. It is important for orthopedic surgeons to understand the pharmacology and reversal of these drugs in the perioperative setting. The purpose of this review is to review the current techniques to monitoring perioperative coagulopathy and to identify the manner in which novel anticoagulant medications affect the clotting cascade with particular interest in trauma and spine surgery.

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Rivaroxaban is as efficient and safe as bemiparin as thromboprophylaxis in knee arthroscopy

Abstract: Our study showed that extended prophylaxis with 10 mg of rivaroxaban once daily for 3 weeks resulted as effective as bemiparin in knee arthroscopy thromboprophylaxis.

Cited by 14 publications

References 30 publications

Rates of Deep Venous Thrombosis and Pulmonary Embolus After Anterior Cruciate Ligament Reconstruction

Rates of Deep Venous Thrombosis and Pulmonary Embolus After Anterior Cruciate Ligament Reconstruction

Venous Thromboembolism After Knee Arthroscopy in Undiagnosed Familial Thrombophilia

Perioperative coagulopathy monitoring

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