Does Prophylactic Administration of Edoxaban Increase D-Dimer Levels after Total Hip Arthroplasty?

Toshiyuki Kawai,Koji Goto,Shuichi Matsuda,Yutaka Kuroda

doi:10.3390/jcm8050678

Abstract

This study aimed to examine the effect of thromboprophylactic edoxaban on D-dimer levels and anemia after total hip arthroplasty (THA). We retrospectively analyzed data from 349 patients undergoing primary THA. Univariate regression and multivariate regression analyses were performed with D-dimer levels on the 7th, 14th, and 21st days postoperatively as the dependent variable Edoxaban use, age, sex, body mass index (BMI), renal function, drop in hemoglobin (Hb) drop, intraoperative blood loss and duration of surgery as were independent variables. Multivariate regression analysis was also performed with Hb drop as the dependent variable. Edoxaban administration of 15 mg/day and 30 mg/day after THA was correlated with higher D-dimer levels at 21, but not at 7 or 14, days postoperatively. Other significant independent predictors for high D-dimer levels were the duration of surgery (at 7 and 14 days), BMI (at 7 days), sex (at 14 days), and age (at 14 and 21 days). Edoxaban use was significantly, weakly correlated with a larger Hb drop at 7 and 14 days, but this was less than a clinically important difference. D-dimer levels after THA can be elevated by thromboprophylactic edoxaban after three weeks postoperatively.

Highlights

Patients who undergo total hip arthroplasty (THA) are at high risk of postoperative venous thromboembolism (VTE)
A recent systematic review showed that new oral anticoagulants, such as rivaroxaban, dabigatran, and apixaban, are cost-effective alternatives to low-molecular-weight heparin to prevent VTE after THA and total knee arthroplasty (TKA) [2]
Higher D-dimer values at postoperative day 7 were significantly correlated with a higher body mass index (BMI) (OR: 1.04, 95%CI: 1.01–1.07, p = 0.015) and duration of surgery (OR: 0.996, 95%CI: 0.991–0.999, p = 0.044) (Table 2)

Summary

Introduction

Patients who undergo total hip arthroplasty (THA) are at high risk of postoperative venous thromboembolism (VTE). A recent systematic review showed that new oral anticoagulants, such as rivaroxaban, dabigatran, and apixaban, are cost-effective alternatives to low-molecular-weight heparin to prevent VTE after THA and total knee arthroplasty (TKA) [2]. Previous studies involving patients who underwent THA showed that oral edoxaban was safe and effective for preventing VTE after total hip arthroplasty [4,5]. With the possible exception of apixaban, newer anticoagulants that lower the risk of postoperative VTE increase bleeding [6]. Administration of 60 mg/day edoxaban resulted in a larger hemoglobin (Hb) drop than 10 mg/day apixaban administration for treatment of DVT after TKA or THA [7]. Fuji et al reported that oral edoxaban 30 mg once daily was superior to subcutaneous enoxaparin 2000 IU twice daily for preventing VTE following THA without increasing the risk for major or clinically relevant non-major bleeding [9]

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Discussion

Conclusion