The Clinical Research For The Prevention Of Deep Vein Thrombosis After Total Hip Or Knee Arthroplasty With Xa Factor Inhibitors: A Prospective Comparative Study

Objective:1.To study the clinical effect of Xa factor inhibitors and low molecular heparin sodium for the prevention of DVT after the artificial total hip or knee arthroplasty.2. To evaluate the adverse events of the three kinds of anticoagulants.Methods:1. Firstly, according to the standard of the entry and removal, we selected 107 patients from 120 patients who were treated with total hip or total knee arthroplasty from October 2009 to Apirl 2011. They were divided into three groups,36 36 35 respectively. Group a was given preventive treatment with rivaroxaban. Group b was given preventive treatment with fondaparinux sodium. Group c was given preventive treatment with low molecular heparin sodium. And then put the three groups for the clinical research. Patients of group a were applied with the rivaroxaban from the postoperative 6 hours of the day 1. And continued the application for 10 days, lOmg, PO, QD. Patients of group b were applied with the fondaparinux sodium from the postoperative 6 hours of the day 1. And continued the application for 10 days,2.5 mg, S.C, QD. Patients of group c were applied with the low molecular heparin sodium from the postoperative 6 hours of the day 1, once. And then continued the application for 10 days, S.C,5000 iu/Q12h. Similarly, three groups were not used the other anticoagulants and affectting blood clotting medication, other preventive measures for the DVT to been same.2. Preoperation, the blood routine, blood clotting and biochemical indicators were checked, with doppler ultrasound tests to eliminate chronic thrombosis. And then postoperative reviewed routine blood, blood clotting in day 4,10, comparing HB, PLT, PT, FIB, ALT of all the patients in the same time;in day 14 used doppler ultrasound to evaluate the rate of the lower limb DVT and recorded perioperative bleeding, subcutaneous ecchymosis to evaluate the adverse events of all cases were surveyed.Results:1.Postoperative,2 cases DVT in group c, with total 5.7%(2/35);2 cases in group a, with total 5.6%(2/36);1 cases in group c, with total 2.8%(1/36);No one pulmonary embolism (PE) in the three groups, The incidence of DVT in all groups was not statistically significant (p=0.752).2. No allergic reaction, hemorrhage of the enteron and cerebral and sedation happened in all cases. But 2 cases in the controlled group had more than 1500 ml blood flow in day 1 after total hip arthroplasty. We stopped the anti-clotting drug and compressed the wound, and then the bleeding stopped; 1 case appeared widely ecchymosis in day 3 in Group a; 1 case of group b appeared widely ecchymosis in day 3 and 4 respectively. The incidences in all groups of the adverse events were not statistically significant (p>0.05).3.The PLT, APTT, PT, FIB, ALT and CREA of the all groups were not statistically significant (p>0.05).Conclusion:1.Although case selected in this study id limited, preliminary results indicate the rate of the DVT after artificial joint replacement using drugs to prevent is lower than the domestic incidence reported in literature.2.Confirm the rivaroxaban and fondaparinux sodium are the same with the gold standard(low molecular heparin sodium)in preventing the DVT after the artificial joint replacement, with safety, low adverse events.3. ALT and PLT are increasing induced by using of the rivaroxaban, which our research shows no harmful to the human body at last.