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Online ISSN 1827-1707
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.