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The impact of elective knee/hip replacement surgery and thromboprophylaxis with rivaroxaban or dalteparin on thrombin generation

Green, L; Lawrie, AS; Patel, S; Hossain, F; Chitolie, A; Mackie, IJ; Haddad, FS; (2010) The impact of elective knee/hip replacement surgery and thromboprophylaxis with rivaroxaban or dalteparin on thrombin generation. BRIT J HAEMATOL , 151 (5) 469 - 476. 10.1111/j.1365-2141.2010.08433.x.

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Abstract

P>Total hip/knee replacement surgeries are associated with an increased risk of venous thromboembolism and post-operative thromboprophylaxis has become standard treatment. This study aimed to: (i) assess the impact of hip/knee replacement surgery on ex vivo thrombin generation (TG), prothrombin fragments 1 + 2 (F1 + 2), thrombin-antithrombin complexes (TAT) and D-dimer; (ii) compare the anticoagulant effects of dalteparin and rivaroxaban on TG 24 h after surgery. Haemostatic variables were assessed in plasma samples of 51 patients taken pre-operatively, peri-operatively, and 24 h post-operatively. Prophylaxis, once a day, with dalteparin or rivaroxaban, starting 6-8 h post-operatively, was administered in 25 (14 knee/11 hip) and 26 patients (13 knee/13 hip) respectively. TG, F1 + 2, TAT and D-dimer increased during surgery. Dalteparin patients showed a variable TG response 24 h after surgery: conversely, the effect of rivaroxaban on TG was consistent across individuals. Good correlation was seen between rivaroxaban levels and TG-lag-time (rs = 0 center dot 46, P = 0 center dot 01); TG-time-to-Peak (rs = 0 center dot 53, P = 0 center dot 005); TG-peak-thrombin (rs = -0 center dot 59, P = 0 center dot 001); and TG-velocity-index-rate (rs = -0 center dot 61, P = 0 center dot 0009). Patients who received rivaroxaban showed a greater decrease of TG, F1 + 2 and TAT (but not D-dimer) than those on dalteparin. TG increases during hip/knee replacement surgery. Rivaroxaban inhibits TG more than dalteparin at 24 h after surgery.

Type: Article
Title: The impact of elective knee/hip replacement surgery and thromboprophylaxis with rivaroxaban or dalteparin on thrombin generation
DOI: 10.1111/j.1365-2141.2010.08433.x
Keywords: dalteparin, hip, knee replacement surgery, rivaroxaban, in vivo, ex vivo thrombin generation, FACTOR-XA INHIBITOR, MOLECULAR-WEIGHT HEPARINS, DEEP-VENOUS THROMBOSIS, TOTAL HIP-ARTHROPLASTY, DOUBLE-BLIND, IN-VITRO, ENOXAPARIN, PLASMA, THROMBOEMBOLISM, COAGULABILITY
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > Research Department of Haematology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
URI: http://discovery.ucl.ac.uk/id/eprint/352027
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