Combined use of topical intraarticular tranexamic acid and rivaroxaban in total knee arthroplasty safely reduces blood loss, transfusion rates, and wound complications without increasing the risk of thrombosis

Yong Tae Kim,Min Wook Kang,Joon Kyu Lee,Joong Il Kim,Young Min Lee

doi:10.1186/s12891-018-2151-2

Abstract

BackgroundBlood loss and deep vein thrombosis (DVT) are important complications after total knee arthroplasty (TKA). Topical tranexamic acid (TXA) effectively reduces wound bleeding but may elevate the risk of DVT. In contrast, rivaroxaban potently prevents DVT but has been associated with bleeding complications. The simultaneous use of topical TXA and rivaroxaban in TKA has not been much investigated.MethodsA retrospective cohort study was conducted with two consecutive groups of patients who underwent TKA. Intraoperatively, one group (RVTX group) received topical, intraarticular TXA, while the other (RV group) did not. Both groups were administered rivaroxaban postoperatively for 14 days and underwent Doppler ultrasound for DVT screening. After propensity score matching, both groups consisted of 52 patients (104 patients in total) and were compared regarding total drain output, nadir haemoglobin (Hb), maximum Hb decrease, calculated total blood loss, transfusion rate, and incidence of DVT and wound complications.ResultsBoth groups showed no significant differences in the propensity-matched variables of age, sex, body mass index, American Society of Anesthesiologists physical status score, and preoperative Hb. The RVTX group showed a significantly higher nadir Hb (p < 0.001), lower drain output (p < 0.001), Hb decrease (p = 0.015), total blood loss (p < 0.001), and rate of transfusion (p < 0.001) and fewer wound complications (p = 0.027). However, the incidence of DVT (p = 1.000) did not differ significantly between the two groups, and all cases were asymptomatic.ConclusionsThe combined use of intraarticular topical TXA with rivaroxaban in patients undergoing TKA is a safe and effective method to reduce blood loss, the need for transfusion, and wound complications without elevating the risk of DVT.

Highlights

Blood loss and deep vein thrombosis (DVT) are important complications after total knee arthroplasty (TKA)
Deep vein thrombosis (DVT) is of a major concern in TKA because it is the main cause of postoperative pulmonary embolism, a potentially life-threatening complication
The objective of this study is to evaluate the efficacy and safety of the combined regimen of topical tranexamic acid (TXA) with rivaroxaban in TKA by comparing groups with or without topical TXA use, both with thromboprophylaxis via rivaroxaban

Summary

Introduction

Blood loss and deep vein thrombosis (DVT) are important complications after total knee arthroplasty (TKA). Topical tranexamic acid (TXA) effectively reduces wound bleeding but may elevate the risk of DVT. Thromboprophylaxis, traditionally using low molecular weight heparin (LMWH), warfarin, and aspirin, has long been a standard postoperative protocol Oral agents such as rivaroxaban, apixaban, and dabigatran have recently been introduced due to their advantages of easier administration, no need for monitoring, and increased or equivalent potency compared to classic anticoagulants. Among these oral drugs, rivaroxaban demonstrated the most effective protection against DVT [12]. Studies have shown higher incidences of wound bleeding and deep surgical site infection [13, 14] in patient groups who were given rivaroxaban after TKA

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