Abstract
Study Aim
To assess the impact of two oral thromboprophylaxis agents against Clexane with regard to range of movement (ROM) following TKR with or without haemostasis following tourniquet release.
Methods & Results
Thromboprophylaxis choice following total knee replacement (TKR) has become of interest with the introduction of oral anticoagulants and support for these by NICE. Specific concerns with oral agents include a perceived elevated level of anti-coagulation and soft tissue complications.
The population (n=264) was subclassified into cohorts regarding thromboprophylaxis cover: Clexane, Rivaroxaban and Dabigatran. Each subgroup was subdivided into whether surgery was performed with or without haemostasis following tourniquet release.
This study demonstrates Clexane is associated with a better and earlier return of ROM post-operatively as compared to oral the thromboprophylaxis agents. This effect was more obvious when combined with haemostasis following early tourniquet release (p< 0.05). The oral thromboprophylaxis agents Rivaroxaban and Dabigatran had a relative negative effect on ROM as compared against Clexane. This was independent of whether the surgery was performed with or without haemostasis following tourniquet release. There was no different between the subgroups with repect to change of serum haemoglobin, symptomatic venous thromboembolism or rate of return to theatre.
Conclusions
This study demonstrates Clexane to have a beneficial effect over the oral anticoagulants, Rivaroxaban and Dabigatran, on ROM and speed of recovery post TKR. This effect was significant (p< 0.05) when combined with genicular vessel haemostasis following early tourniquet release.
We hypothesise independent of intra-operative haemostasis of genicular vessels after torniquet release, elevated small vessel ooze secondary to the oral thromboprophylaxis has a detrimental impact on ROM post TKR.
