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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2013 December;64(6):575-81
Clinical experience with rivaroxaban in antiaggregated patients undergoing total hip and knee arthroplasty
Grappiolo G. 1, Scardino M. 1, Martorelli F. 1, Astore F. 1, Mazziotta G. 1, Ferrari M. 1, Quaini S. 2 ✉
1 Operative Unit of Prosthetic Surgery, Istituto Clinico Humanitas, Rozzano, Milan, Italy;
2 Department of Anesthesia and Resuscitation USL2, Pietra Ligure, Savona, Italy
Aim: Many patients scheduled for elective orthopedic surgery are ready receiving antiplatelet treatment for secondary cardiovascular prophylaxis. For several years now our Department has been following a protocol that requires these patients ‑ unless otherwise indicated ‑ to be switched from an antiplatelet treatment to low-molecular-weight heparin (LMWH).
Methods: For this study we prospectively collected data on a sample of patients already under antiplatelet treatment needing peri-operative thromboprophylaxis after hip or knee arthroplasty. All the patients received the following treatment: seven days before surgery antiplatelet agents were discontinued and patients received LMWH until the second or third postoperative day, when rivaroxaban was introduced at a daily dose of 10 mg for 35 days. Of the 336 patients, 216 (64.3%) underwent hip surgery and 120 knee surgery (35.7%). Outcome measures included the incidence of symptomatic deep vein thrombosis (DVT) and the frequency of major and minor bleeds or thrombotic accidents.
Results: During the 35 days of treatment, there were no clinically detected DVT or pulmonary embolism and no fatal or major bleeds; only 10 (3.0%) minor bleeds occurred, no thrombotic accidents .
Conclusion: This schedule of pharmacological thromboprophylaxis in previously antiplatelet-treated patients undergoing hip or knee arthroplasty appears to be safe and effective.