Clinical Study Of Bridging Anticoagulant In Perioperative Period Of Total Hip Arthroplasty

Objective:To observe the safety and efficacy of rivaroxaban periprocedural anticoagulation strategies in patients with long term warfarin anticoagulant undergoingtotal hip arthroplasty.Methods:40 patients with cardio-cerebrovascular diseases who need long-term warfarin anticoagulation undergoing total hip arthroplasty.from Dec 2015 to Dec 2017 were enrolled.After perfect examination,they were randomly divided into two groups,They were divided into 2 groups.In Group 1,Low molecular weight heparin bridged anticoagulant(LMWH)group(20 cases),warfarin was stopped 5 days before surgery and bridged with low molecular weight heparin(LMWH)3 days before surgery,Withdrawal 12 hours before surgery and LMWH bridging followed by warfarin alone after suegery.In Group 2 Rivaroxaban bridged anticoagulant group(20 cases),warfarin was stopped 5 days before surgery and bridged with Rivaroxaban 3 days before surgery,Withdrawal 24 hours before surgery and Rivaroxaban bridging followed by warfarin alone after surgery.Two groups of patients with anticoagulant bridge were connected to the international standard ratio of coagulation index(INR)to reach the target range,and then continued anticoagulant therapy with warfarin alone.The volume of blood loss,postoperative drainage,the decrease of hemoglobin before and after operation,the blood transfusion rate,the time of hospitalization,the incidence of embolism and hemorrhage and other complications were compared between the two groups during 3-month follow-up.Results:there was no statistical significance in the volume of blood loss,postoperative drainage,the decrease of hemoglobin before and after operation,the blood transfusion rate(P> 0.05),However,the postoperative wound drainage volume in the rivaroxaban bridginganticoagulant group was significantly lower than that in the low molecular weight heparin group(P<0.05).The anticoagulant bridging time and hospitalization time of rivaroxabanbridged anticoagulant group were shorter than that of low molecular weight heparin bridged anticoagulant group,there was statistical significance between 2 groups(P<0.05).there were 4 patients with poor wound healing in group1,and 2 in group 2,after active dressing change,the wound healed well.No embolism occurred during hospitalization in both groups,and 2 cases of embolism occurred in group1,4 cases of mild hemorrhage events occurred in group 1,1 case of embolization event occurred in group 2,3 cases of mild hemorrhage event occurred in group 2 during 3-month follow-up,there was no statistical significance in Comparison of the incidence of embolism events and bleeding events between the two groups(P>0.05).Conclusions:Perioperative anticoagulant bridging therapy of total hip arthroplasty is ge--nerally safe and effective.Compared with traditional Low molecular weight heparin bridged anticoagulant(LMWH)strategy,Perioperative rivaroxaban bridging anticoagulant warfarin st--ragety doesn't increase the risk of hemorrhage and embolism,convenient to take,shorten the hospitalization time,conducive to the early rehabilitation of patients,worthing of further rese--arch and promotion.