Using a combination of tranexamic acid and rivaroxaban in total knee replacements reduces transfusion requirements: A prospective cohort study

Wood, Alexander; Smith, Ruth S.; Keenan, A.; Brenkel, Ivan J.; Walmsley, P

doi:10.1016/j.jajs.2014.07.001

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…With intravenous TXA, Wang et al [ 17 ] reported less blood loss and a lower rate of transfusion and wound complications in the rivaroxaban-IV TXA group, with no significant difference in DVT occurrence. Wood et al [ 20 ] also reported a significantly reduced need for transfusion in the same patient group. Similar results with intraarticular TXA were produced by Wang et al [ 22 ] with a dose of 0.5 g in a 10 mL solution, and Yen et al [ 27 ] with a dose of 3 g in a 100 mL solution.…”

Section: Discussionmentioning

confidence: 84%

“…However, it is plausible that when TXA and rivaroxaban are used together, the actions of one drug may compensate for the adverse effects of the counterpart drug. Nevertheless, many studies regarding the use of TXA in TKA involved a thromboprophylaxis regimen other than rivaroxaban [ 15 – 19 ]; only a few analysed the concurrent use of TXA with rivaroxaban in TKA [ 20 – 22 ]. In most of these studies, TXA was administered intravenously, although topical TXA has been shown to be noninferior to intravenous injections in reducing blood loss, with a minimal resultant systemic concentration [ 19 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Combined use of topical intraarticular tranexamic acid and rivaroxaban in total knee arthroplasty safely reduces blood loss, transfusion rates, and wound complications without increasing the risk of thrombosis

Kim

Kang

Lee

et al. 2018

BMC Musculoskelet Disord

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BackgroundBlood loss and deep vein thrombosis (DVT) are important complications after total knee arthroplasty (TKA). Topical tranexamic acid (TXA) effectively reduces wound bleeding but may elevate the risk of DVT. In contrast, rivaroxaban potently prevents DVT but has been associated with bleeding complications. The simultaneous use of topical TXA and rivaroxaban in TKA has not been much investigated.MethodsA retrospective cohort study was conducted with two consecutive groups of patients who underwent TKA. Intraoperatively, one group (RVTX group) received topical, intraarticular TXA, while the other (RV group) did not. Both groups were administered rivaroxaban postoperatively for 14 days and underwent Doppler ultrasound for DVT screening. After propensity score matching, both groups consisted of 52 patients (104 patients in total) and were compared regarding total drain output, nadir haemoglobin (Hb), maximum Hb decrease, calculated total blood loss, transfusion rate, and incidence of DVT and wound complications.ResultsBoth groups showed no significant differences in the propensity-matched variables of age, sex, body mass index, American Society of Anesthesiologists physical status score, and preoperative Hb. The RVTX group showed a significantly higher nadir Hb (p < 0.001), lower drain output (p < 0.001), Hb decrease (p = 0.015), total blood loss (p < 0.001), and rate of transfusion (p < 0.001) and fewer wound complications (p = 0.027). However, the incidence of DVT (p = 1.000) did not differ significantly between the two groups, and all cases were asymptomatic.ConclusionsThe combined use of intraarticular topical TXA with rivaroxaban in patients undergoing TKA is a safe and effective method to reduce blood loss, the need for transfusion, and wound complications without elevating the risk of DVT.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Combined use of topical intraarticular tranexamic acid and rivaroxaban in total knee arthroplasty safely reduces blood loss, transfusion rates, and wound complications without increasing the risk of thrombosis

Kim

Kang

Lee

et al. 2018

BMC Musculoskelet Disord

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“…Additionally, 1 study focused on the tranexamic acid and rivaroxaban in TKR, finding that patients with the use of rivaroxaban needed more requirement of BTR, compared to those using the tranexamic acid. [ 33 ]…”

Section: Discussionmentioning

confidence: 99%

Rivaroxaban improves hidden blood loss, blood transfusion rate and reduces swelling of the knee joint in knee osteoarthritis patients after total knee replacement

Zhang

Liu²,

Sun³

et al. 2018

Medicine

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Osteoarthritis (OA) is the third most common diagnosis made by general practitioners in older patients. The purpose of the current study is to investigate effects rivaroxaban had on both hidden blood loss and blood transfusion rate (BTR) in patients with knee OA (KOA) after going through a total knee replacement (TKR).Between the time periods of December 2011 up until January 2015, a total of 235 patients underwent TKR and were selected to be assigned to either the rivaroxaban or nonanticoagulant groups. Coagulation function indexes before surgery and following administration of rivaroxaban, total blood loss, hidden blood loss, dominant blood loss, blood transfusion volume, hemoglobin reduction, degree of postoperative pain (visual analogue scale), the degree of knee swelling, and range of motion following surgery were all recorded. Hospital for special surgery (HSS) scores offered an objective evaluation for the knee joint functions before surgery at the intervals of 2 weeks and after surgery at intervals of 3 months, 6 months, 12 months, and 24 months.Patients in the rivaroxaban group had shown a higher hidden blood loss, as well as a higher BTR, compared to those involved in the nonanticoagulant group. BTR was found to have been 49.59% in the rivaroxaban group, and 35.09% for the nonanticoagulant group. Patients in the rivaroxaban group had lower degrees of knee swelling than those involved in the nonanticoagulant group. There was no deep vein thrombosis (DVT) detected in the rivaroxaban group, whereas 5 DVT cases were detected in the nonanticoagulant group. In the rivaroxaban group, the HSS scores of the knee joint functions were remarkably higher at the 2-week mark in succession to the surgery than those involved with the nonanticoagulant group.This overall data demonstrated that KOA patients after TKR had presented with a higher hidden blood loss, BRT, and lower swelling degrees of the knee joint after being treated by the rivaroxaban.

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The Efficacy of Combined Use of Rivaroxaban and Tranexamic Acid on Blood Conservation in Minimally Invasive Total Knee Arthroplasty a Double-Blind Randomized, Controlled Trial

Wang

Chen

Lin

et al. 2017

The Journal of Arthroplasty

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Using a combination of tranexamic acid and rivaroxaban in total knee replacements reduces transfusion requirements: A prospective cohort study

Cited by 3 publications

References 23 publications

Combined use of topical intraarticular tranexamic acid and rivaroxaban in total knee arthroplasty safely reduces blood loss, transfusion rates, and wound complications without increasing the risk of thrombosis

Combined use of topical intraarticular tranexamic acid and rivaroxaban in total knee arthroplasty safely reduces blood loss, transfusion rates, and wound complications without increasing the risk of thrombosis

Rivaroxaban improves hidden blood loss, blood transfusion rate and reduces swelling of the knee joint in knee osteoarthritis patients after total knee replacement

The Efficacy of Combined Use of Rivaroxaban and Tranexamic Acid on Blood Conservation in Minimally Invasive Total Knee Arthroplasty a Double-Blind Randomized, Controlled Trial

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