Thromboprophylaxis Treatment Does Not Affect Hemoglobin and Hematocrit Levels After Elective Total Hip Arthroplasty
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Published:
Oct 17, 2024
Keywords:
Anemia, hip, arthroplasty, thromboprophylaxis
Main Article Content
Abstract
Background: Postoperative anemia is a significant complication in patients undergoing total hip arthroplasty (THA). The primary objective of this study was to evaluate the prevalence of postoperative anemia in patients undergoing elective THA and to determine whether there is a relationship with the thromboprophylactic treatment used.
Materials and Methods: This was a prospective randomized trial. A total of 358 patients who underwent elective THA between February 2019 and January 2022 were included. Patients were divided into three groups receiving daily thromboprophylaxis: rivaroxaban 10 mg, enoxaparin sodium 40 mg, or aspirin 100 mg.
Results: No confirmed cases of thromboembolic disease or severe bleeding were reported. Hemoglobin and hematocrit levels were consistent across all treatment groups, with no statistically significant differences. There were no differences in complication rates among the groups. However, iron supplementation was significantly higher in the enoxaparin group (p = 0.041). In the ordinal regression model, the incidence of anemia was associated with age (OR 1.02, 95% CI 1.00-1.05, p = 0.04), male sex (OR 0.33, 95% CI 0.19-0.56, p < 0.01), and the presence of any comorbidity (OR 0.49, 95% CI 0.28-0.85, p = 0.012).
Conclusions: The thromboprophylaxis treatments evaluated in this study had no impact on the development of postoperative anemia in patients undergoing THA. Male sex, age, and the presence of comorbidities appear to be the factors most negatively influencing the development of anemia. No significant differences were found in the safety profiles of the three thromboprophylaxis therapies.
Materials and Methods: This was a prospective randomized trial. A total of 358 patients who underwent elective THA between February 2019 and January 2022 were included. Patients were divided into three groups receiving daily thromboprophylaxis: rivaroxaban 10 mg, enoxaparin sodium 40 mg, or aspirin 100 mg.
Results: No confirmed cases of thromboembolic disease or severe bleeding were reported. Hemoglobin and hematocrit levels were consistent across all treatment groups, with no statistically significant differences. There were no differences in complication rates among the groups. However, iron supplementation was significantly higher in the enoxaparin group (p = 0.041). In the ordinal regression model, the incidence of anemia was associated with age (OR 1.02, 95% CI 1.00-1.05, p = 0.04), male sex (OR 0.33, 95% CI 0.19-0.56, p < 0.01), and the presence of any comorbidity (OR 0.49, 95% CI 0.28-0.85, p = 0.012).
Conclusions: The thromboprophylaxis treatments evaluated in this study had no impact on the development of postoperative anemia in patients undergoing THA. Male sex, age, and the presence of comorbidities appear to be the factors most negatively influencing the development of anemia. No significant differences were found in the safety profiles of the three thromboprophylaxis therapies.
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How to Cite
Iglesias, S. L., Almada, A. G., López, P. D., Pioli, I. J., Mangupli, M. M., Gómez, J. M., & Allende, B. L. (2024). Thromboprophylaxis Treatment Does Not Affect Hemoglobin and Hematocrit Levels After Elective Total Hip Arthroplasty. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(5), 450-461. https://doi.org/10.15417/issn.1852-7434.2024.89.5.1958
Section
Clinical Research
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References
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complications after total hip arthroplasty. J Arthroplasty 2020;35(6S):S214-S218. https://doi.org/10.1016/j.arth.2020.01.012
2. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in
patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 1999;81(1):2-10. https://doi.org/10.2106/00004623-199901000-00002
3. Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literatura. Anesthesiology 2010;113(2):482-95. https://doi.org/10.1097/ALN.0b013e3181e08e97
4. Myers E, Grady PO, Dolan AM. The influence of preclinical anaemia on outcome following total hip replacement. Arch Orthop Trauma Surg 2004;124(10):699-701. https://doi.org/10.1007/s00402-004-0754-6
5. Steuber TD, Howard ML, Nisly SA. Strategies for the management of postoperative anemia in elective orthopedic surgery. Ann Pharmacother 2016;50(7):578-85. https://doi.org/10.1177/1060028016647977
6. Izushi Y, Shiota N, Tetsunaga T, Shimada K, Egawa T, Kiuchi T, et al. The clinical impact of edoxaban for the
patients with postoperative anemia after total hip arthroplasty. Eur J Orthop Surg Traumatol 2018;28(7):1349-58.
https://doi.org/10.1007/s00590-018-2212-0
7. Bala A, Murasko MJ, Burk DR, Huddleston 3rd JI, Goodman SB, Maloney WJ, et al. Venous thromboprophylaxis
after total hip arthroplasty: aspirin, warfarin, enoxaparin, or factor Xa inhibitors? Hip Int 2020;30(5):564-71.
https://doi.org/10.1177/1120700019841600
8. Chen AF, Klatt BA, Yazer MH, Waters JH. Blood utilization after primary total joint arthroplasty in a large hospital network. HSS J 2013;9(2):123-8. https://doi.org/10.1007/s11420-013-9327-y
9. Tan TL, Foltz C, Huang R, Chen AF, Higuera C, Siqueira M, et al. Potent anticoagulation does not reduce venous
thromboembolism in high-risk patients. J Bone Joint Surg Am 2019;101(7):589-99. https://doi.org/10.2106/JBJS.18.00335
10. Eriksson BI, Borris LC, Friedman RJ, Haas S, Huisman MV, Kakkar AK, et al. Rivaroxaban versus enoxaparin for
thromboprophylaxis after hip arthroplasty. N Engl J Med 2008;358(26):2765-75. https://doi.org/10.1056/NEJMoa0800374
11. Matharu GS, Kunutsor SK, Judge A, Blom AW, Whitehouse MR. Clinical effectiveness and safety of aspirin for
venous thromboembolism prophylaxis after total hip and knee replacement: a systematic review and meta-analysis of randomized clinical trials. JAMA Intern Med 2020;180(3):376-84. https://doi.org/10.1001/jamainternmed.2019.6108
12. Muscatelli SR, Zheng H, Hughes RE, Cowen ME, Hallstrom BR. Non-inferiority of aspirin for venous
thromboembolism prophylaxis After hip arthroplasty in a statewide Registry. J Arthroplasty 2021;36(6):2068-2075. e2. https://doi.org/10.1016/j.arth.2021.01.025
13. Matharu GS, Garriga C, Whitehouse MR, Rangan A, Judge A. Is aspirin as effective as the newer direct oral
anticoagulants for venous thromboembolism prophylaxis after total hip and knee arthroplasty? An analysis from the National Joint Registry for England, Wales, northern Ireland, and the Isle of Man. J Arthroplasty 2020;35(9):2631-2639.e6. https://doi.org/10.1016/j.arth.2020.04.088
complications after total hip arthroplasty. J Arthroplasty 2020;35(6S):S214-S218. https://doi.org/10.1016/j.arth.2020.01.012
2. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in
patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 1999;81(1):2-10. https://doi.org/10.2106/00004623-199901000-00002
3. Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literatura. Anesthesiology 2010;113(2):482-95. https://doi.org/10.1097/ALN.0b013e3181e08e97
4. Myers E, Grady PO, Dolan AM. The influence of preclinical anaemia on outcome following total hip replacement. Arch Orthop Trauma Surg 2004;124(10):699-701. https://doi.org/10.1007/s00402-004-0754-6
5. Steuber TD, Howard ML, Nisly SA. Strategies for the management of postoperative anemia in elective orthopedic surgery. Ann Pharmacother 2016;50(7):578-85. https://doi.org/10.1177/1060028016647977
6. Izushi Y, Shiota N, Tetsunaga T, Shimada K, Egawa T, Kiuchi T, et al. The clinical impact of edoxaban for the
patients with postoperative anemia after total hip arthroplasty. Eur J Orthop Surg Traumatol 2018;28(7):1349-58.
https://doi.org/10.1007/s00590-018-2212-0
7. Bala A, Murasko MJ, Burk DR, Huddleston 3rd JI, Goodman SB, Maloney WJ, et al. Venous thromboprophylaxis
after total hip arthroplasty: aspirin, warfarin, enoxaparin, or factor Xa inhibitors? Hip Int 2020;30(5):564-71.
https://doi.org/10.1177/1120700019841600
8. Chen AF, Klatt BA, Yazer MH, Waters JH. Blood utilization after primary total joint arthroplasty in a large hospital network. HSS J 2013;9(2):123-8. https://doi.org/10.1007/s11420-013-9327-y
9. Tan TL, Foltz C, Huang R, Chen AF, Higuera C, Siqueira M, et al. Potent anticoagulation does not reduce venous
thromboembolism in high-risk patients. J Bone Joint Surg Am 2019;101(7):589-99. https://doi.org/10.2106/JBJS.18.00335
10. Eriksson BI, Borris LC, Friedman RJ, Haas S, Huisman MV, Kakkar AK, et al. Rivaroxaban versus enoxaparin for
thromboprophylaxis after hip arthroplasty. N Engl J Med 2008;358(26):2765-75. https://doi.org/10.1056/NEJMoa0800374
11. Matharu GS, Kunutsor SK, Judge A, Blom AW, Whitehouse MR. Clinical effectiveness and safety of aspirin for
venous thromboembolism prophylaxis after total hip and knee replacement: a systematic review and meta-analysis of randomized clinical trials. JAMA Intern Med 2020;180(3):376-84. https://doi.org/10.1001/jamainternmed.2019.6108
12. Muscatelli SR, Zheng H, Hughes RE, Cowen ME, Hallstrom BR. Non-inferiority of aspirin for venous
thromboembolism prophylaxis After hip arthroplasty in a statewide Registry. J Arthroplasty 2021;36(6):2068-2075. e2. https://doi.org/10.1016/j.arth.2021.01.025
13. Matharu GS, Garriga C, Whitehouse MR, Rangan A, Judge A. Is aspirin as effective as the newer direct oral
anticoagulants for venous thromboembolism prophylaxis after total hip and knee arthroplasty? An analysis from the National Joint Registry for England, Wales, northern Ireland, and the Isle of Man. J Arthroplasty 2020;35(9):2631-2639.e6. https://doi.org/10.1016/j.arth.2020.04.088