Risk factors for ecchymosis in patients receiving rivaroxaban for thromboprophylaxis after total knee arthroplasty: a retrospective cohort study

Abstract

What is known and objective: Ecchymosis of the limb is commonly seen after total knee arthroplasty (TKA) when using anticoagulants for thromboprophylaxis, but it is unknown which factors may predispose patients to an increased risk. The aim of this study was to evaluate risk factors for ecchymosis in patients receiving rivaroxaban after TKA. Methods: A retrospective, single-centre cohort analysis was conducted. The electronic medical records of patients admitted to the Department of Orthopedics during January 2018 to December 2019 and who received rivaroxaban 10 mg daily after TKA were reviewed for documentation of ecchymosis. Baseline demographics, laboratory values and surgical information were included for analysing their relationship with ecchymosis. Results and discussion: A total of 227 patients were included in the study. Among them, 54 patients (23.8%) developed ecchymosis, and 173 did not. The ecchymosis group had a higher proportion of patients with a body weight >60 kg [83.33% vs. 50.00%, p = 0.0004] and hypertension [61.11% vs 41.46%, p = 0.0304]. The ecchymosis group also had a higher BMI [26.04 ± 2.71 kg/m 2 vs 24.52 ± 3.18 kg/m 2 , p = 0.0066] mean arterial pressure (MAP) recorded from post-operation day 1 to day 3 [105.21 mmHg vs 91.52 mmHg, p = 0.0003]. However, serum albumin concentrations before surgery [3.85 g/dL vs. 4.20 g/dL, p = 0.0225] and on post-operation day 3 [3.50 g/dL vs. 3.91 g/dL, p = 0.0370] were lower in the ecchymosis group. Serum haemoglobin on post-operation day 3 was also lower [10.07 g/dL vs. 11.57 g/dL, p = 0.0459]. Five risk factors for ecchymosis were identified by binary logistic regression: mean MAP (from POD1 to POD3) (OR=2.

Activated Partial Thromboplastin Time or Prothrombin Time Prolongation During Rivaroxaban Administration: Clinical Risk Factors and Outcomes Analysis

“…Our previous study showed that patient BMI (OR 2.513, 95% CI 1.929-3.011, P < .001) was an independent risk factor for limb ecchymosis in rivaroxaban users after total knee arthroplasty. 24 In contrast, BMI was not found to be an independent risk factor for aPTT/PT prolongation.…”

“…1.929-3.011, P < .001) was an independent risk factor for limb ecchymosis in rivaroxaban users after total knee arthroplasty. 24 In contrast, BMI was not found to be an independent risk factor for aPTT/PT prolongation. Our findings showed that a higher percentage of patients were found to be premedicated with parenteral anticoagulants, primarily LMWH in the group with prolonged aPTT/PT during rivaroxaban administration.…”

The Role of Anti-Factor Xa Activity in the Management of Ecchymosis in Patients Receiving Rivaroxaban after Total Knee Arthroplasty

“…There are some limitations to the present study. Firstly, the small sample size of this study may result in the underestimation of some variables, such as older age, HBL, albumin and hemoglobin level, which were already reported as the risk factors of ecchymosis [5,39,40]. Secondly, since chromogenic aFXa assay was performed only on POD1 and POD3 due to some objective reasons, we failed to provide the dynamic monitoring of aFXa levels in this study.…”