A novel oral chemoprophylactic agent for venous thromboembolism after Total Knee Arthroplasty - is it safe?

Abstract

Introduction: Venous thromboembolism and postoperative wound drainage and subsequent infection are both serious complications after primary total knee arthroplasty (TKA). The balance between bleeding and clotting is a dilemma. Newer agents include direct factor Xa inhibitor is quoted to have superior efficacy to prevent deep vein thrombosis compared with low-molecular-weight heparin without increasing side-effect of major blood loss. This study aimed to examine the safety profile of a novel factor Xa inhibitor (Apixaban) used in Chinese patients. Materials and Methods: A total of 40 consecutive patients (8 male and 32 female) with a mean age of 73.6 (range, 54- 84) years requiring unilateral TKA were recruited. Twenty patients received a course of 2-week 2.5 mg Apixaban twice daily as chemoprophylaxis. The wound condition, soaking of gauze, swelling of the limb, perioperative haemoglobin and haematocrit, renal function, C-reactive protein, thromboembolism, and bleeding complication were documented. Another 20 patients undergoing a course of 2-week 300 mg aspirin daily as chemoprophylaxis were compared. Results: Preoperative mechanical alignment of both groups was comparable. The drain output, frequency of wound dressing, and soaking of dressing between the groups were comparable. There was neither thromboembolism nor bleeding complications. Both groups showed a sustained and comparable increase in haemoglobin and haematocrit and stable renal function. There was no surgical site infection. Discussion and Conclusion: The early experience using Apixaban as chemoprophylaxis in TKA is safe. Longer period of use of the drug is required to monitor its efficacy and safety.