2015 ISAKOS Biennial Congress ePoster #1416
Venous Thromboembolism after Total Knee Arthroplasty in Korean Patients: Prospective Randomized Study Using Multidetector Row Computer Tomography-Indirect Venography
Choong-Hyeok Choi, MD, PhD, Seoul KOREA, REPUBLIC OF
Kyu Sung Chung, MD, PhD, Prof., Seoul KOREA, REPUBLIC OF
Jin-Kyu Lee, MD, Seoul KOREA, REPUBLIC OF
Il-Hoon Sung, Prof, Seoul KOREA, REPUBLIC OF
Dong Won Kim, Prof, Seoul KOREA, REPUBLIC OF
Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, KOREA
FDA Status Cleared
Summary: Ten days rivaroxavan was more effective for PE and VTE prevention than seven days rivaroxavan with no increasing bleeding complications
We investigated the incidence of venous thromboembolism (VTE) and pulmonary embolism (PE) after total knee arthroplasty (TKA) and assessed the efficacy and complications of three different chemical prophylactic regimens.
MATERIALS & METHODS
From May, 2011 to November 2013, 268 patients, 330 knees were randomly allocated to three groups, low molecular weight heparin (LMWH) 5000IU for 2 days followed by aspirin 100mg for 5 days (Group HA, 110 knees), rivaroxaban 10mg for 7 days (Group X7, 110 knees), or for 10 days (Group X10, 110 knees) postoperatively. Intermittent pneumatic compression device was applied on all patients. The multidetector row computed tomography (MDCT) was done at postoperative 10 days to evaluate VTE (PE & DVT separately), and MDCT was rechecked to evaluate the changes of VTE at postoperative 3 months in VTE patients. Additionally, major and minor bleeding complications, amounts of bleeding, and bruise around wound were checked.
The incidence of VTE was 42 (38.2%) in Group HA, 22 (20.0%) in Group X7, 11 (10.0%) in Group X10. Deep vein thrombosis (DVT) was revealed 39 (35.5%) in Group HA, 17 (15.5%) in Group X7, 8 (7.3%) in Group X10. Group HA showed statistically higher prevalence in VTE and DVT than rivaroxavan groups. PE was detected 21 (19.1%) in Group HA, 11 (10.0%) in Group X7, 3 (2.7%) in Group X10. Group X10 was statistically significantly lower PE incidence than Group HA (p=0.0001) and Group X7 (p=0.027). Asymptomatic distal DVT was completely resolved in 88.8% with no specific treatment. There was no major or minor bleeding complications and bleeding amounts were not statistically different in 3 groups.
Rivaroxaban has better prophylactic efficacy with no increasing bleeding complications than LMWH followed by aspirin. Ten days rivaroxaban was more effective for PE and VTE prevention than 7 days rivaroxavan. However, most of reduced VTEs were asymptomatic and distal DVTs.