This study aimed to compare the efficacy and safety of aspirin, rivaroxaban and low-molecular-weight heparin (LMWH) for post total knee arthroplasty (TKA) deep vein thrombosis (DVT) prophylaxis. Between July 2011 and July 2013, a prospective randomized controlled trial was performed on 324 patients with osteoarthritis who underwent primary unilateral TKA. Twelve hours after the surgery, Group A was given oral rivaroxaban at a dose of 10 mg/day. Group B was given subcutaneous LMWH at a dose of 4000 AxaIU (0.4 ml)/day and Group C was given oral aspirin at a dose of 100 mg/day. All three groups were treated for 14 days, and all of the patients were followed for 4 weeks. The incidence of DVT, dominant/hidden blood loss, the incidence of wound complications and the incidence of subcutaneous ecchymosis in the affected extremities were compared between the three groups. The incidence of DVT was lower in Group A compared with the other two groups [3 (2.94%) vs. 14 (12.50%), P = 0.029; 3 (2.94%) vs. 18 (16.36%), P = 0.017]. However, hidden blood loss [1.71 (1.19-2.97) vs. 1.18 (0.77-2.31), P = 0.009; 1.71 (1.19-2.97) vs. 1.30 (0.61-2.43), P = 0.004] and wound complications [5 (4.90) vs. 3 (2.67), P = 0.027; 5 (4.90) vs. 2 (1.82), P = 0.014] were more common in Group A than in the other groups. There were no significant differences between Group B and Group C in the incidence of DVT [14 (12.50%) vs. 18 (16.36%), P = 0.831], hidden blood loss [1.18 (0.77-2.31) vs. 1.30 (0.61-2.43), P = 0.327] or wound complications [3 (2.67) vs. 2 (1.82), P = 0.209]. No significant differences in the incidence of limb swelling were found between the three groups [38 (37.25%) vs. 28 (25.00%) vs. 24 (21.82%), P = 0.247]. Group A had a higher incidence of subcutaneous ecchymosis in the affected extremities than Group C [74 (72.55%) vs. 54 (49.09%), P = 0.039], but there were no significant differences between Groups A and B [74 (72.55%) vs. 62 (55.36%), P = 0.193] or between Groups B and C [62 (55.36%) vs. 54 (49.09%), P = 0.427]. Rivaroxaban has a positive anticoagulation effect but leads to increases in both postoperative blood loss and wound complications in patients. Hence, clinicians using rivaroxaban for anticoagulant therapy should closely monitor the changes in the hemoglobin level and wound healing and promptly supplement blood volume and provide other symptomatic and supportive treatments. No significant difference in post-TKA DVT prophylaxis was found between aspirin and LMWH, and the former can be used as part of a multimodal anticoagulation therapy.
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【Administering aspirin, rivaroxaban and low-molecular-weight heparin to prevent deep venous thrombosis after total knee arthroplasty.].
【在全膝关节置换术后给予阿司匹林，利伐沙班和低分子量肝素以预防深静脉血栓形成。】
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DOI：10.1097/MBC.0000000000000121文章类型：杂志文章
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：本研究旨在比较阿司匹林，利伐沙班和低分子量肝素（LMWH）在全膝关节置换术后（TKA）预防深静脉血栓形成（DVT）的有效性和安全性。在2011年7月至2013年7月之间，对324例行原发性单侧TKA的骨关节炎患者进行了一项前瞻性随机对照试验。手术后十二小时，给A组口服利伐沙班口服，剂量为10μg/天。 B组给予皮下注射LMWH，剂量为4000 AxaIU（0.4μml）/天，C组给予口服阿司匹林，剂量为100μgIU/天。三组均治疗14天，所有患者均随访4周。比较了三组患肢的DVT发生率，显性/隐性失血，伤口并发症的发生率和皮下瘀斑的发生率。与其他两组相比，A组的DVT发生率较低[3（2.94％）vs. 14（12.50％），P = 0.029; 3（2.94％）对18（16.36％），P = 0.017]。然而，隐性失血[1.71（1.19-2.97）对1.18（0.77-2.31），P = 0.009； 1.71（1.19-2.97）对1.30（0.61-2.43），P = 0.004]和伤口并发症[5（4.90）对3（2.67），P = 0.027； A组中5（4.90）vs. 2（1.82），P2 = 0.014]比其他组更常见。 B组和C组之间DVT的发生率无显着差异[14（12.50％）vs. 18（16.36％），P = 0.831]，隐性失血[1.18（0.77-2.31）vs.1.30（0.61） -2.43），P = 0.327]或伤口并发症[3（2.67）对2（1.82），P = 0.209]。三组之间肢体肿胀的发生率没有显着差异[38（37.25％）vs. 28（25.00％）vs. 24（21.82％），P = 0.247]。 A组患肢皮下瘀斑的发生率高于C组[74（72.55％）vs. 54（49.09％），P = 0.039]，但A组和B组之间无显着差异[74（72.55） ％）vs. 62（55.36％），P = 0.193]或在B组和C组之间[62（55.36％）vs. 54（49.09％），P = 0.427]。利伐沙班具有积极的抗凝作用，但会导致术后失血量增加和患者伤口并发症增加。因此，使用利伐沙班进行抗凝治疗的临床医生应密切监测血红蛋白水平和伤口愈合的变化，并迅速补充血容量并提供其他对症和支持治疗。阿司匹林和LMWH在TKA预防DVT预防方面无显着差异，前者可作为多模式抗凝治疗的一部分。
