title: Clinical Assessment of Postoperative Anemia Associated with Edoxaban in Patients Undergoing Total Knee Arthroplasty Compared to Fondaparinux.
abstract: Edoxaban, an oral direct factor Xa inhibitor, was developed and approved for anticoagulant thromboprophylaxis after total knee arthroplasty (TKA). We retrospectively investigated the postoperative anemia by oral administration of edoxaban 30 mg compared with fondaparinux 2.5 mg in TKA patients. Two hundred twenty nine patients who underwent TKA in National Hospital Organization Okayama Medical Center from July 2010 to June 2012 were divided into two groups; pre and post approval of edoxaban: fondaparinux-group (F-group) and edoxaban-group (E-group). As the primary endpoint, the frequency of postoperative anemia was evaluated. Blood coagulation values and relations between these parameters and postoperative anemia were also investigated. The frequency of postoperative anemia was significantly higher in E-group than F-group patients (52.7% vs. 37.8%; p<0.05). Hemoglobin (Hgb) levels were decreased with the peak at postoperative day (POD) 3 in both groups, and the change of Hgb values from POD1 (ΔHgb) was significantly increased in the E-group (p=0.04). At each POD, prothrombin time (PT) and international normalized ratio of PT (PT-INR) prolonged from the preoperative day in E-group were significantly higher than F-group. Additionally, PT and PT-INR in the E-group at POD3 were significantly prolonged in patients with postoperative anemia and the sensitivity of cut-off values to predict postoperative anemia was superior to the activated partial thromboplastin time (APTT). Thus, as the frequency of postoperative anemia tended to be higher in E-group, edoxaban 30 mg might require vigilance, and prolonged PT and PT-INR could potentially predict edoxaban-associated postoperative anemia after TKA.
authors.affiliation: Department of Pharmacy, National Hospital Organization Okayama Medical Center.
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Izushi
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Takami
authors.forename: Naofumi
authors.initials: N
authors.lastname: Shiota
authors.forename: Tomonori
authors.initials: T
authors.lastname: Tetsunaga
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ookura
authors.forename: Kenichi
authors.initials: K
authors.lastname: Shimada
authors.forename: Takashi
authors.initials: T
authors.lastname: Egawa
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Kiuchi
authors.forename: Toru
authors.initials: T
authors.lastname: Sato
authors.forename: Ritsugi
authors.initials: R
authors.lastname: Takuma
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000139:chemically induced*; D019645:Arthroplasty, Replacement, Knee; D065427:Factor Xa Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D000077425:Fondaparinux; D006801:Humans; D007279:Injections, Subcutaneous; D019934:International Normalized Ratio; D008297:Male; D010314:Partial Thromboplastin Time; D011134:Polysaccharides / Q000009:adverse effects* / Q000627:therapeutic use; D011183:Postoperative Complications; D011517:Prothrombin Time; D011725:Pyridines / Q000009:adverse effects* / Q000627:therapeutic use; D013844:Thiazoles / Q000009:adverse effects* / Q000627:therapeutic use; D013927:Thrombosis / Q000517:prevention & control
chemical_list: D065427:Factor Xa Inhibitors; D011134:Polysaccharides; D011725:Pyridines; D013844:Thiazoles; D000077425:Fondaparinux; C552171:edoxaban