Clinical efficacy of rivaroxaban combined with topical application of tranexamic acid in primary total hip arthroplasty

Objective To explore the effect of rivaroxaban combined with local use of tranexamic acid in primary total hip arthroplasty(THA). Methods Inclusion criteria: age≥60 years, primary THA, no rivaroxaban and ammoniacal acid allergy. Exclusion criteria: deep venous thrombosis, pulmonary embolism or abnormal preoperative blood vessels, abnormal blood routine and blood coagulation dysfunction, cardiovascular and cerebrovascular diseases, severe cardiopulmonary renal insufficiency. A total of 146 patients undergoing primary total hip arthroplasty in the orthopedic department of the Second Affiliated Hospital of Xi’an Jiaotong University from January 2012 to January 2014 were selected and divided into the rivaroxaban + tranexamic acid group (the treatment group, n=73) and the rivaroxaban group(the control group, n=73). The following continuous variables were analyzed by t test: age, body mass index(BMI), operation time, total and intraoperative blood loss, drainage volume, preoperative hemoglobin(Hb), hematocrit(HCT) and coagulation index, as well as postoperative Hb, HCT, coagulation index on the 3rd day and Harris hip function score in the 6th month. The following discrete variables were analyzed by Chi-square test: gender, disease types, transfusion cases. Results There was no significant difference in age(t=0.657, P>0.05), gender(χ2=0.068, P>0.05), BMI(t=1.026, P>0.05), disease types(χ2=0.383, P>0.05) or operation time(t=0.193, P>0.05)between the two groups. The total blood loss(t=16.876, P<0.05), drainage volume(t=15.203, P<0.05), transfusion cases(χ2=6.032, P<0.05) in the experimental group were significantly less than those in the control group, the differences were statistically significant ; the postoperative Hb (t=4.874, P<0.05)and HCT(t=5.768, P<0.05)of the experimental group were significantly higher than those of the control group on the 3rd day. The postoperative hrombosis events didn’t occur in the two groups. Conclusion Combined application of tranexamic acid and rivaroxaban in the primary THA of elderly patients does not affect the blood coagulation system, which can reduce the risk of postoperative thrombosis and the blood loss. Key words: Arthroplasty, replacement, hip; Rivaroxaban; Tranexamic acid; Venous thrombosis; Blood loss, surgical