Using a combination of tranexamic acid and rivaroxaban in total knee replacements reduces transfusion requirements: A prospective cohort study

IntroductionThe risk of venous thromboembolism (VTE) is high in orthopaedics. Oral direct factor Xa inhibitors have been introduced to help reduce the incidence of VTE. To reduce post-operative bleeding antifibrinolytics are used.AimWe aimed to ascertain the effect of two drugs on post-operative bleeding and transfusion requirements.MethodsWe prospectively recorded patient demographics, operative details, complications, transfusion incidence and VTE incidence in TKR patients. We also sent out a questionnaire to patients asking about wound bleeding and VTE. All patients were given 10 mg rivaroxaban 8 h post-operatively and then once a day for 14 days. Patients given tranexamic acid were given 500 mg IV, 5 min prior to wound closure at the discretion of the surgeon. VTE was confirmed by Doppler or CTPA as Deep Vein Thrombus or Pulmonary Embolism. Minor bleed was categorised as dressing soakage or reported wound leakage, major bleed as haematoma requiring revision within 30 days.Results509 patients underwent TKR: 200 (39%) only received rivaroxaban (Group 1), 296 (58%) also received tranexamic acid (Group 2). 13 (3%) of patients had no data available. 5 patients had a VTE: 4 (2%) Group 1, 1 (0.3%) Group 2 (P < 0.05). 39 patients had a minor bleed: 17 (8.5%) Group 1, 22 (7.4%) Group 2 (P = 0.5). 2 patients had major bleeds: 1 (0.5%) Group 1, 1 (0.33%) Group 2 (P = 0.69). Blood transfusions 21 (10.5%) Group 1, 9 (3%) Group 2 (P < 0.0001).ConclusionsWe have demonstrated a reduced requirement for blood transfusions in the tranexamic acid group. However our results whilst they show a trend towards decrease bleeding rates in both the minor and major bleeds are not significant, requiring larger studies looking at wound bleeding and leakage.