A comparative study of thromboelastography-aid assessment on the efficacy of anticoagulants after total knee arthroplasty

Abstract

Objective To provide theoretical guidance for clinical practice, by conducting a comparative study on the efficacy of apixaban and low-molecular-weight heparins using thromboelastography (TEG) after total knee arthroplasty (TKA). Methods A total of 144 patients who had undergone single-knee TKA were selected (random double blind, 57 every group), and assigned to an apixaban group or a low-molecular-weight heparins group. TEG was executed at four time points: pre-surgery, 24 h after surgery, 3 days after surgery, and 7 days after surgery. The effect of the two drugs on coagulation function was analyzed through comparing the corresponding coagulation reaction time (R), blood cell clot formation time (K), blood cell clot formation rate (α), maximum amplitude (MA), LY 30 and coagulation index (CI) of TEG after TKA. Results The values of R, K and α in the apixaban group were higher than those in the low-molecular-weight heparins group at all three time points (24-hour after surgery P=0.032, 3-day after surgery P=0.019, 7-day after surgery P=0.013; K: 24-hour after surgery P=0.017, 3-day after surgery P=0.028, 7-day after surgery P=0.036). The MA levels in the groups were reduced after TKA at all three sampling points. The LY30 value before operation was higher than that at 24 h after surgery and 3 days after surgery, but lower than that at 7 days after surgery. The postoperative CI value in the two groups was within normal range at 24 h after surgery and 3 days after surgery. The CI value in the apixaban group was larger than that in the low-molecular-weight heparins group at 7 days after surgery. Conclusion Apixaban and low-molecular-weight heparins are both effective for thromboprophylaxis after TKA, and apixaban is especially powerful to reduce blood coagulation. Key words: Thromboelastography; Apixaban; Low-molecular-weight heparins; Total knee arthroplasty