Comparison Of Two Xa Factor Inhibitors In The Treatment Of Calf Muscular Vein Thrombosis After Total Knee Arthroplasty

Background and objectiveBy replacing the damaged surface of the knee with special joint prostheses,total knee arthroplasty has become an effective method for the treatment of end-stage knee diseases.Due to the aggravation of the aging population and the increase of obesity,the incidence of knee osteoarthritis is on the rise,and thus the global demand for total knee arthroplasty is increasing year by year.At present,about 2 million cases of total knee arthroplasty are carried out worldwide every year,and some scholars estimate that more than 1 million patients will have this operation by 2025 in China.The incidence of calf muscular vein thrombosis after total knee arthroplasty is as high as 62%due to various factors such as use of tourniquet,surgical injury to vascular endothelium and hypercoagulability of blood after operation.If it is not properly treated,calf muscular vein thrombosis will progress to the proximal vein,and the correlation rate between it and pulmonary embolism is found to be 15%-33%clinically.Therefore,great attention must be paid to the formation of calf muscular vein thrombosis after total knee arthroplasty to reduce the occurrence of dangerous events.However,there are no relevant guidelines to guide the anticoagulant treatment of calf muscular vein thrombosis,and there is a lack of prospective,randomized controlled studies,and no consensus has been reached in relevant studies.Rivaroxaban and apixaban belong to new oral Xa factor inhibitors,and they bind to the active sites of factor Xa in a direct and reversible way to reduce the production of thrombin in endogenous and exogenous coagulation pathways,inhibit platelet aggregation and fibrin formation,so as to prevent the formation of new thrombosis and promote the dissolution of existing thrombosis together with the body’s fibrolytic system.Compared with traditional anticoagulants,new oral Xa factor inhibitors have been widely used in clinical anticoagulant therapy because of their advantages such as no need for frequent monitoring and dose adjustment,high specificity and wide indication.Rivaroxaban and apixaban have different molecular structures,dosage and frequency,and different pharmacokinetics.So far,no study has reported the efficacy comparison of rivaroxaban and apixaban in the treatment of calf muscular vein thrombosis after total knee arthroplasty.Therefore,by observing patients with calf muscular vein thrombosis after total knee arthroplasty,this study comparing the actual curative effect and safety of rivaroxaban and apixaban,in order to to provide reference for the treatment of calf muscular vein thrombosis after total knee arthroplasty.MethodsA total of 70 patients with calf muscular vein thrombosis after unilateral total knee arthroplasty in the Department of Orthopedics,the First Affiliated Hospital of Zhengzhou University from September 2018 to December 2019 were selected and divided into rivaroxaban group and apoxaban group according to the order of admission.Among them,35 patients were given rivaroxaban tablet(Xarelto,Bayer)10mg/time,once a day,for 12w;35 patients were given apixaban tablets(Eliquis,Pfizer)2.5mg/time,twice a day,for 12w.Thrombosis dissolution,hemoglobin changes,subcutaneous ecchymosis,D-dimer variation range,thrombosis progression and pulmonary embolism formation,incision infection events,and hematoma were observed and compared between the two groups during treatment.SPSS 21.0 software was used for data processing.Measurement data was represented by x±s and counting data was represented by rate(%).Kolmogorov-Smirnov was used to test the normality of the two groups of data.If they met the normal test,two independent samples t-test was used to compare the measurement data,and χ2 test was used to compare the counting data.The non-normal distribution data were analyzed by rank sum test.P<0.05 indicated that the difference between the two groups of data was statistically significant.After 1w,4w and 12w of treatment,there was no statistically significant difference in thrombolysis efficiency between the two groups(P>0.05),and there was also no statistically significant difference in D-dimer change range between the two groups(P>0.05).There were statistically significant differences in hemoglobin change and ecchymosis change between the two groups in 1w and 4w after treatment(P<0.05).The thrombus>10mm diameter was difficult to dissolve completely within 12w.No thrombosis progression,pulmonary embolism,incision infection or peripheral hematoma occurred in all patients.ConclusionRivaroxaban and apoxaban are safe and effective in the treatment of calf muscular vein thrombosis after total knee arthroplasty with similar thrombolysis efficiency.Diameter of calf muscular vein thrombosiss>10mm is difficult to dissolve completely within 12 weeks of treatment.The incidence of latent blood loss and subcutaneous ecchymosis at 1w and 4w after treatment in apoxaban group was lower than that in rivaroxaban group,showing better short-term clinical effect.