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.
Tranexamic acid (TXA) was reportedly to decrease postoperative blood loss after standard total knee arthroplasty (TKA). However, the blood-conservation effect of TXA in minimally invasive TKA, in particular, receiving a direct oral anticoagulant was unclear. The aim of the study was to investigate the efficacy of combined use of TXA and rivaroxaban on postoperative blood loss in primary minimally invasive TKA.



In a prospective, randomized, controlled trial, 198 patients were assigned to placebo (98 patients, normal saline injection) and study group (100 patients, 1g TXA intraoperative injection) during primary unilateral minimally invasive TKA. All patients received rivaroxaban 10 mg each day for 14 doses postoperatively. Total blood loss was calculated from the maximum hemoglobin drop after surgery plus amount of transfusion. The transfusion rate and wound complications were recorded in all patients. Deep-vein thrombosis was detected by ascending venography of the leg 15 days postoperatively.



The mean total blood loss was lower in the study group (1020 mL [95% confidence interval, 960-1080 mL]) compared with placebo (1202 mL [95% confidence interval, 1137-1268 mL]) (P < .001). The transfusion rate was lower in the study group compared with placebo (1% vs 8.2%, P = .018). Postoperative wound hematoma and ecchymosis were higher in placebo than the study group (P = .003). There was no symptomatic deep-vein thrombosis or pulmonary embolism in either group.



Systemic administration of TXA can effectively reduce the postoperative blood loss which results in lower rate of transfusion requirement and wound hematoma in minimally invasive TKA patients when rivaroxaban is used for thromboprophylaxis. Rivaroxaban has a high rate of bleeding complications when used alone in TKA patients.
Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
Jun-Wen
JW
Wang
Institute of Public Health, National Yangming University, Taipei, Taiwan.
Bradley
B
Chen
Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
Po-Chun
PC
Lin
Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
Shih-Hsiang
SH
Yen
Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
Chung-Cheng
CC
Huang
Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
Feng-Chih
FC
Kuo
D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D065427:Factor Xa Inhibitors / Q000008:administration & dosage*; D005260:Female; D006406:Hematoma / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines; D019106:Postoperative Hemorrhage; D011184:Postoperative Period; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control; D000069552:Rivaroxaban / Q000008:administration & dosage*; D013876:Thiophenes; D014148:Tranexamic Acid / Q000008:administration & dosage*; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control
D000933:Antifibrinolytic Agents; D065427:Factor Xa Inhibitors; D009025:Morpholines; D013876:Thiophenes; D014148:Tranexamic Acid; D000069552:Rivaroxaban
rivaroxaban; total blood loss; total knee arthroplasty; tranexamic acid; venous thromboembolism; wound complications