Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 4 Issue 11

Hemarthrosis Resulting from Venous Thromboembolism Prophylaxis in the Postoperative Ambulatory Orthopedic Sports Medicine Patient: A Retrospective Study of Rivaroxaban Versus Enoxaparin

Brian P Davis1*, Darshan Patel1, Michelle M Coleman1 and Anup Shah2

1Department of Orthopedic Surgery, Baylor College of Medicine, Houston, USA
2Kelsey-Seybold Clinic, West Holcombe Blvd, Houston, USA

*Corresponding Author: Brian P Davis, Department of Orthopedic Surgery, Baylor College of Medicine, Houston, USA.

Received: September 20, 2021; Published: October 04, 2021

×

Abstract

Purpose: The purpose of this study was determining the risk of hemarthrosis associated with prophylactic administration of rivaroxaban and enoxaparin in an ambulatory postoperative sports medicine patient population after knee arthroscopic procedures.

Methods: A retrospective observational chart review was performed for 214 patients [aged 16 to 53] who underwent arthroscopic knee surgery performed at a single surgical center between November 2011 and December 2016 and received postoperative VTE chemoprophylaxis. All patients were prescribed postoperative thromboprophylaxis with either rivaroxaban (dosed 10 mg orally every 24 hours for ten days) or enoxaparin (dosed 40mg subcutaneously every 24 hours for ten days). These patients were followed for a minimum three-month period post-operatively. All patients were evaluated at two and six weeks postoperatively and joint aspiration was performed if patients presented with painful and clinically significant knee swelling/effusion (grade 2+ to 3+) and/or limited range of motion. Deep vein thrombosis was ruled out by Doppler ultrasound if clinically suspected. Patients were excluded if age was less than 16 years or were not prescribed postoperative thromboprophylactic medication.

Results: Our data revealed that while there was no incidence of DVT in either group, 12.5% of patients in the rivaroxaban cohort were found to have clinically significant hemarthrosis versus 1.6% of patients in the enoxaparin group (Odds Ratio 8.9; CI 1.912 - 41.034, p-value = 0.0053).

Conclusion: If a surgeon chooses to prescribe chemoprophylaxis for ambulatory postoperative sports medicine patients, this study supports consideration of avoiding rivaroxaban, given the higher risk of a symptomatic hemarthrosis in the early postoperative period.

Keywords: Arthroscopic Knee; Hemarthrosis; Sports Medicine; Thromboprophylaxis; Venous Thromboembolism

×

References

  1. Stringer MD., et al. “Deep vein thrombosis after elective knee surgery. An incidence study in 312 patients”. The Journal of Bone and Joint Surgery British 71 (1989): 492-497.
  2. Janssen RP., et al. “Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: A systematic review”. World Journal of Orthopaedics 7 (2016): 604-617.
  3. Krych AJ., et al. “Incidence and Risk Factor Analysis of Symptomatic Venous Thromboembolism After Knee Arthroscopy”. Arthroscopy 31 (2015): 2112-2118.
  4. Falck-Ytter Y., et al. “Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines”. Chest 141 (2012): e278S-e325S.
  5. Ye S., et al. “The incidence of deep venous thrombosis after arthroscopically assisted anterior cruciate ligament reconstruction”. Arthroscopy 29 (2013): 742-747.
  6. Erickson BJ., et al. “Rates of Deep Venous Thrombosis and Pulmonary Embolus After Anterior Cruciate Ligament Reconstruction: A Systematic Review”. Sports Health 7 (2015): 261-266.
  7. Demers C., et al. “Incidence of venographically proved deep vein thrombosis after knee arthroscopy”. Archives of Internal Medicine 158 (1998): 47-50.
  8. Jaureguito JW., et al. “The incidence of deep venous thrombosis after arthroscopic knee surgery”. American Journal of Sports Medicine 27 (1999): 707-710.
  9. Maletis GB., et al. “Incidence of symptomatic venous thromboembolism after elective knee arthroscopy”. The Journal of Bone and Joint Surgery American 94 (2012): 714-720.
  10. Cullison TR., et al. “The incidence of deep venous thrombosis in anterior cruciate ligament reconstruction”. Arthroscopy 12 (1996): 657-659.
  11. Schippinger G., et al. “Thromboembolic complications after arthroscopic knee surgery. Incidence and risk factors in 101 patients”. Acta Orthopaedica Scandinavica 69 (1998): 144-146.
  12. Gaskill T., et al. “The Prevalence of Symptomatic Deep Venous Thrombosis and Pulmonary Embolism After Anterior Cruciate Ligament Reconstruction”. American Journal of Sports Medicine 43 (2015): 2714-2719.
  13. Graham WC and Flanigan DC. “Venous thromboembolism following arthroscopic knee surgery: a current concepts review of incidence, prophylaxis, and preoperative risk assessment”. Sports Medicine 44 (2014): 331-343.
  14. Delis KT., et al. “Incidence, natural history and risk factors of deep vein thrombosis in elective knee arthroscopy”. Thrombosis and Haemostasis 86 (2001): 817-821.
  15. Bogunovic L M., et al. “The role of deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction”. Operative Techniques in Sports Medicine 24 (2015): 73-76.
  16. Jacobs JJ., et al. “American Academy of Orthopaedic Surgeons clinical practice guideline on: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty”. The Journal of Bone and Joint Surgery American 94 (2012): 746-747.
  17. Sturgill LP., et al. “Interrater reliability of a clinical scale to assess knee joint effusion”. Journal of Orthopaedic and Sports Physical Therapy 39 (2009): 845-849.
  18. Keller RA., et al. “Deep Venous Thrombosis Prophylaxis in Anterior Cruciate Ligament Reconstructive Surgery: What Is the Current State of Practice?” Sports Health 10 (2018): 156-159.
  19. Hirsh J., et al. “Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety”. Chest 119 (2001): 64S-94S.
  20. Samama MM. “The mechanism of action of rivaroxaban--an oral, direct Factor Xa inhibitor--compared with other anticoagulants”. Thrombosis Research 127 (2011): 497-504.
  21. Marlovits S., et al. “Extended-duration thromboprophylaxis with enoxaparin after arthroscopic surgery of the anterior cruciate ligament: a prospective, randomized, placebo-controlled study”. Arthroscopy 23 (2007): 696-702.
  22. “Thromboseprophylaxe in der ambulanten kniechirurgie - Untersuchung an uber 2000 arthroskopierten patienten”. Orthop Praxis 10/95 (1995): 681-683.
  23. Wirth T., et al. “Prevention of venous thromboembolism after knee arthroscopy with low-molecular weight heparin (reviparin): Results of a randomized controlled trial”. Arthroscopy 17 (2001): 393-399.
  24. Michot M., et al. “Prevention of deep-vein thrombosis in ambulatory arthroscopic knee surgery: A randomized trial of prophylaxis with low--molecular weight heparin”. Arthroscopy 18 (2002): 257-263.
  25. Camporese G., et al. “Low-molecular-weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: a randomized trial”. Annals of Internal Medicine 149 (2008): 73-82.
  26. Lassen MR., et al. “The effects of rivaroxaban on the complications of surgery after total hip or knee replacement: results from the RECORD programme”. The Journal of Bone and Joint Surgery. British 94 (2012): 1573-1578.
  27. Camporese G., et al. “Efficacy of Rivaroxaban for thromboprophylaxis after Knee Arthroscopy (ERIKA). A phase II, multicentre, double-blind, placebo-controlled randomised study”. Thrombosis and Haemostasis 116 (2016): 349-355.
  28. Munoa L., et al. “Rivaroxaban is as efficient and safe as bemiparin as thromboprophylaxis in knee arthroscopy”. Musculoskeletal Surgery 98 (2014): 21-25.
×

Citation

Citation: Brian P Davis., et al. “Hemarthrosis Resulting from Venous Thromboembolism Prophylaxis in the Postoperative Ambulatory Orthopedic Sports Medicine Patient: A Retrospective Study of Rivaroxaban Versus Enoxaparin".Acta Scientific Orthopaedics 4.11 (2021): .




Metrics

Acceptance rate33%
Acceptance to publication20-30 days

Indexed In



News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is June 25, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US