ORIGINAL ARTICLES   

Minerva Ortopedica e Traumatologica 2013 December;64(6):575-81

Copyright © 2013 EDIZIONI MINERVA MEDICA

language: English

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.