Thromboprophylaxis after minimally invasive total knee arthroplasty: A comparison of rivaroxaban and enoxaparin

Background: Total knee arthroplasty (TKA) carries a substantial rate of venous thromboembolism (VTE). The blood-saving of effect of tranexamic acid (TEA) in TKA using enoxaparin for thromboprophylaxis has been well known. However, the routine use of chemoprophylaxis in TKA remains controversial because of postoperative bleeding complications. Therefore, the purpose of this study was to retrospectively compare the incidence of VTE, and postoperative blood loss and wound-related complications in minimally invasive (MIS)-TKA patients who received rivaroxaban or enoxaparin prophylaxis. Methods: A total of 113 patients who underwent primary unilateral MIS-TKA between 2009 and 2012 were studied. Of these, 61 patients (study group) received rivaroxaban prophylaxis between 2011 and 2012 and a control group of 52 patients received enoxaparin prophylaxis between 2009 and 2010. All patients received one intraoperative injection of TEA (10 mg/kg). We compared the changes in hemoglobin (Hb) level, postoperative drainage amount, total blood loss, transfusion rate, and incidence of postoperative wound complications and VTE between the two groups. Results: No differences in postoperative Hb levels, blood drainage amount, total blood loss, and transfusion rate were observed between the two groups. No deep-vein thrombosis of the leg or pulmonary embolism was noted in both groups. There were no major wound complications including hematoma and infection requiring surgical intervention for open irrigation or debridement. Conclusions: Our retrospective study demonstrated a low rate of VTE in MIS-TKA patients who received rivaroxaban or enoxaparin when TEA was used for bleeding prophylaxis. No increased perioperative bleeding or postoperative wound-related complications were observed in the rivaroxaban group compared with the enoxaparin group.