Abstract
Background
The incidence of bleeding following primary TKR has increased with the use of chemical thromboprophylaxis. Our aim was to compare Clexane, Apixaban and Rivaroxaban in terms of frequency and volume of bleeding episodes, need for blood transfusion, return to theatre and incidence of VTE events.
Methods
Between February and May 2014, a consecutive series of 132 primary TKRs were studied prospectively. The wound dressings of these patients were assessed daily to look for signs of bleeding and classified into: Mild (< 50p size coin), moderate (> 50p size coin) or Severe (blood seeping through the dressing). Follow up was up to minimum of 30 days post discharge.
Results
Apixaban, Rivaroxaban & Clexane were used in 64, 23 and 45 patients respectively. Eleven patients had at least 1 day of mild bleeding, 8 had at least 1 day of moderate bleeding and 11 had at least 1 day of severe bleeding. Ten patients had 1 or more doses omitted because of bleeding. However, there was no statistical significance in distribution of bleeding episodes or doses omitted due to bleeding amongst the three drugs (chi squared test). There was also no correlation between number of severe bleeding episodes and the need for blood transfusion. There were two VTE events recorded; 1 PE each in the Apixaban and Rivaroxaban groups. Two cases in the Apixaban group and 1 case in the Clexane group returned to theatre for washout of haematoma.
Conclusion
There was an 8% incidence of severe bleeding in our study group. The incidence of bleeding problems following TKR was similar in the Apixaban, Rivaroxaban & Clexane groups.
Level of evidence
III - Evidence from case, correlation, and comparative studies.
