Abstract
PurposeEven today, total knee arthroplasty (TKA) is associated with venous thromboembolism (VTE). The purpose of our study is to report the incidence of postoperative VTE and to compare the efficacy of commonly used orally administered antithrombotic agents.Materials and methodsSeven hundred ad ninety-nine patients who underwent primary TKA were retrospectively reviewed. The patients were prescribed one of three antithrombotic agents: aspirin (n = 168), rivaroxaban (n = 117), or apixaban (n = 514). Before surgery, patient demographics and risk factors were matched via propensity scoring. After surgery, all three groups took the agent for 7 days and underwent ultrasonography to check for VTE.ResultsThe overall incidence of postoperative VTE was 15.4% (123/799). Only one patient developed symptomatic VTE. Female sex and staged bilateral TKA were risk factors for postoperative VTE. The postoperative VTE rates in the aspirin, rivaroxaban, and apixaban groups were 16.2%, 6.0%, and 17.1%, respectively, significantly lower in the rivaroxaban group (p < 0.02). The majority of VTEs in all three groups were calf-vein thromboses.ConclusionsAll agents showed enough efficacy as antithrombotic agents. Considering that aspirin is inexpensive, aspirin is a cost-effective option for preventing postoperative VTE.
Highlights
Total knee arthroplasty (TKA) is effective for treating advanced degenerative arthritis of the knee
The postoperative venous thromboembolism (VTE) rates in the aspirin, rivaroxaban, and apixaban groups were 16.2%, 6.0%, and 17.1%, respectively, significantly lower in the rivaroxaban group (p < 0.02)
It was found that female sex and staged bilateral total knee arthroplasty (TKA) were significant VTE risk factors with odds ratios of 3.94 and 1.75, respectively (Table 2)
Summary
Total knee arthroplasty (TKA) is effective for treating advanced degenerative arthritis of the knee. Patients undergoing artificial joint surgery have an average of two to three comorbidities and 33% have five or more [1, 2], increasing the risk for complications after surgery [3]. Given the increased numbers of artificial joint surgeries in elderly patients, the numbers of patients with comorbidities will likely increase [4], as will the rate of complications. Venous thromboembolism (VTE) is a principal cause of mortality in the 3 to 6 months after surgery, and may progress to a pulmonary embolism [5]. The incidence of VTE after TKA varies from 1.5% to 41.7% [6]. Common risk factors for VTE include a previous history of VTE, venous insufficiency, congenital heart failure, obesity, trauma, immobilization, and infectious disease [3, 7]. Prevention of postoperative VTE requires significant resources [7]
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