The impact of elective knee/hip replacement surgery and thromboprophylaxis with Rivaroxaban or Dalteparin on Thrombin Generation

Laura Green (1) , Andrew S Lawrie (2) , Shelain Patel (3) , Fahad Hossain (3) , Andrew Chitolie (2) , Ian Mackie (4) , Fares S Haddad (3) , Sam Machin (5)

1 Haemostasis Research Unit
2 Haemostasis Research Unit
3 Department of Orthopaedics
4 Haematology
5 Haematology

Total hip/knee replacement surgeries are associated with an increased risk of venous thromboembolism and post-operative thromboprophylaxis has become standard treatment. The aims of this study were to: (1) 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; (2) compare the anticoagulant effects of dalteparin and rivaroxaban on TG 24 hours after surgery. Haemostatic variables were assessed in plasma samples of 51 patients taken: pre-operatively; peri-operatively; and 24 hours post-operatively. Prophylaxis, once a day, with dalteparin or rivaroxaban, starting 6-8 hours 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 hours 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=0.46, p=0.01); TG-time-to-Peak (rs=0.53, p=0.005); TG peak-thrombin (rs=-0.59, p=0.001); and TG-velocity-index-rate (rs=-0.61, p=0.0009). Patients who received rivaroxaban showed a greater decrease of TG, F1+2 and TAT (but not D-dimer) than those on dalteparin. During hip/knee replacement surgery there is an increase in TG. Rivaroxaban inhibits TG more than dalteparin at 24 hours after surgery.

Mots clés: Medicine

Laura Green, Andrew S Lawrie, Shelain Patel, Fahad Hossain, Andrew Chitolie, et al.. The impact of elective knee/hip replacement surgery and thromboprophylaxis with Rivaroxaban or Dalteparin on Thrombin Generation. British Journal of Haematology, 2010, 151 (5), pp.469. ⟨10.1111/j.1365-2141.2010.08433.x⟩. ⟨hal-00586599⟩