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

Abstract

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

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Citation

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

Copyright

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.