Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 5 Issue 11

Role of Rivaroxaban and Apixaban in Hip Replacement

LB Gaikovaya1, KN Zamyatina1, SA Saiganov1, Maryam Jamil2, Ehsan Ul Haq3*, AN Tkachenko1, D Sh Mansurov1 and IL Urazovskaya1

1North-Western State Medical University Named After I.I. Mechnikov Ministry of Health of the Russian Federation, Saint-Petersburg, Russia
2Department of General Surgery, Ghurki Trust Hospital, Lahore Medical and Dental College (LMDC) Lahore, Pakistan
3Department of Orthopedics, Services Hospital Lahore, Services Institute of Medical Sciences (SIMS) Lahore, Pakistan

*Corresponding Author: Ehsan Ul Haq, Department of Orthopedics, Services Hospital Lahore, Services Institute of Medical Sciences (SIMS) Lahore, Pakistan.

Received: September 29, 2022; Published: October 19, 2022


Introduction: Direct oral anticoagulants significantly reduce the risk of venous thromboembolic complications. However, in some cases in patients with latent hemostasis disorders, the use of drugs of this group (most often rivaroxaban and apixaban) may be accompanied by an increased risk of postoperative bleeding after hip arthroplasty.

Materials and Methods: 38 patients were under observation, from the clinic of traumatology and orthopedics of the North-western State Medical University named after I.I. Mechnikov, Saint Petersburg, in connection with the planned hip replacement for osteoarthritis. The average age of patients was 58 ± 15 (33; 85) years. Depending upon the anticoagulant taken, patients were divided into 2 groups. The first group - 25 patients receiving rivaroxaban and the second - 13 patients - apixaban. All patients underwent laboratory tests before surgery (baseline), on the first day after surgery (while taking anticoagulant) and on the 7th day after surgery. The laboratory study included determination of hemostasis parameters (INR, APTT, Fibrinogen, D-dimer) on the STA Compact analyzer (Stago, France), biochemical parameters (total calcium, ionized calcium, serum iron, C-reactive protein) on the COBAS Integra 400plus analyzer and hematological parameters on the LH-500 analyzer (Beckman Coulter, USA).

Results and Discussion: When evaluating biochemical parameters, patients in both groups had statistically significant decreases in total calcium, ionized calcium, serum iron after surgery compared with baseline data. At the same time, the concentration of C-reactive protein was significantly increased in both groups. Patients treated with rivaroxaban showed a statistically significant increase in INR (p < 0.05) in contrast to the group of patients treated with apixaban. After surgery, patients treated with rivaroxaban and apixaban showed a significant increase in fibrinogen and D-dimer concentrations.

Conclusions: The use of direct oral anticoagulants after hip replacement is not accompanied by hemorrhagic complications. The evaluation of plasma concentrations of apixaban and rivaroxaban demonstrated the efficacy of anticoagulant effects of direct coagulation factor Xa inhibitors and proved the need for their use in the prevention of thrombotic complications in patients after hip arthroplasty.

Keywords: Hip Replacement; Direct Anticoagulants; Rivaroxaban; Apixaban; Bleeding


  1. Tsed AN., et al. “Pathological damage of bones and joints in patients on hemodialysis in Saint Petersburg”. Nephrology (Saint-Petersburg)6 (2019): 73-82.
  2. Furustrand TU., et al. “Role of rifampin against propionibacterium acnes biofilm in vitro and in an experimental foreign-body infection model”. Antimicrobial Agents and Chemotherapy4 (2012): 1885-1891.
  3. Shoji MM., et al. “Biofilms in periprosthetic joint infections: a review of diagnostic modalities, current treatments, and future directions”. Journal of Knee Surgery2 (2020): 119-131.
  4. Zagorodny NV., et al. “20-year experience in endoprosthesis of large joints in the specialized department of CITO named after N.N. Priorova”. West. Traumatology and Orthopedics 2 (2011): 52-58.
  5. Andreeva TM. “Injuries, orthopedic morbidity, the status of trauma and orthopedic care to the population of Russia in 2017 Ministry of Health of Russia, Federal State Budgetary Institution "N.N. Priorov National Medical Research Center”. "Theler" (2018): 148-149.
  6. Weiser MC., et al. “The current state of screening and decolonization for the prevention of staphylococcus aureus surgical site infection after total hip and knee arthroplasty”. Journal of Bone and Joint Surgery 17 (2017): 1449-1458.
  7. Aggarwal VK., et al. “Surgical approaches for primary total hip arthroplas-ty from Charnley to now. The quest for the best approach”. JBJS Reviews1 (2020): e0058.
  8. Slobodskoy AB., et al. “Complex prevention of early thrombohemorrhagic complications in endoprosthesis of large joints”. All things. congress of orthopedic traumatologists. Publishing House "Man and Health" (2014): 403-404.
  9. Elbuluk AM., et al. “Respiratory synchronized versus intermittent pneumat-ic compression in prevention of venous thromboembolism after total joint arthroplasty: a systematic review and meta-analysis”. Orthopedic Clinics of North America 2 (2018): 123-133.
  10. Pedersen AB., et al. “Association between fixation technique and revision risk in total hip arthroplasty patients younger than 55 years of age. Results from the Nordic Arthroplasty Register Association”. Osteoarthritis Cartilage5 (2014): 659-667.
  11. Lin PC., et al. “The blood-saving effect of tranexamic acid in minimally in-vasive total knee re-placement: is an additional pre-operative injection effective?” Journal of Bone and Joint Surgery 7 (2012): 932-936.
  12. Artemyev EV., et al. “Hematomas in the field of hip joint after total endoprosthesis”. IX Congress of Orthopedic Traumatologists. Saratov: Scientific 1 (2010): 309-310.
  13. Sychev DA., et al. “Clinico-Pharmacological and Clinical Basis of Multiplicity of Intake of Novel Oral Anticoagulants”. Cardiology11 (2017): 84-93.
  14. Cuker A., et al. “Laboratory measurement of anticoagulant activity of non-vitamin K oral anticoagulants”. Journal of the American College of Cardiology11 (2014): 1128-1139.
  15. Lindhoff-Last E., et al. “Assays for measuring rivaroxaban: their suitability and limitations”. Therapeutic Drug Monitoring 6 (2010): 673-679.
  16. Kochish AA., et al. “Improvement of Perioperative Management of Patients Undergoing Surgical Treatment for Hip Periprosthetic Joint Infection”. Traumatology and Orthopedics of Russia1 (2021): 143-152.


Citation: Ehsan Ul Haq., et al. “Role of Rivaroxaban and Apixaban in Hip Replacement". Acta Scientific Orthopaedics 5.11 (2022): 122-127.


Copyright: © 2022 Ehsan Ul Haq., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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