Yonsei Med J.  2019 Jul;60(7):626-632. 10.3349/ymj.2019.60.7.626.

Comparison of Apixaban and Low Molecular Weight Heparin in Preventing Deep Venous Thrombosis after Total Knee Arthroplasty in Older Adults

• Jiang H
• Meng J
• Guo T
• Zhao JN
• Wang YC
• Wang J
• Qiu Y
• Ding H

• KMID: 2450402
• DOI: http://doi.org/10.3349/ymj.2019.60.7.626

Abstract

PURPOSE
To compare the effect of apixaban and low molecular weight heparin (LMWH) in the prevention and treatment of deep venous thrombosis (DVT) after total knee arthroplasty in older adult patients.
MATERIALS AND METHODS
A total of 220 patients (average age of 67.8±6.4 years) undergoing total knee arthroplasty were randomly selected as research subjects and were divided into apixaban and LMWH groups (110 in each group).
RESULTS
The incidence of DVT was lower in the apixaban group than in the LMWH group (5.5% vs. 20.0%, p=0.001). Activated partial thromboplastin times (35.2±3.6 sec vs. 33.7±2.2 sec, p=0.010; 37.8±4.6 sec vs. 34.1±3.2 sec, p<0.001; 39.6±5.1 sec vs. 35.7±3.0 sec, p=0.032) and prothrombin times (14.0±1.0 sec vs. 12.8±0.9 sec, p<0.001; 14.5±1.2 sec vs. 13.0±1.1 sec, p<0.001; 15.3±1.4 sec vs. 13.2±1.3 sec, p=0.009) in the apixaban group at 1 week after surgery, 3 weeks after surgery, and the end of treatment were higher than those in the LMWH group. Platelet and fibrinogen levels in the apixaban group were lower than those of the LMWH group. Also, capillary plasma viscosity and erythrocyte aggregation in the apixaban group at 1 week after surgery, 3 weeks after surgery, and the end of treatment were lower than those in the LMWH group.
CONCLUSION
Apixaban, which elicits fewer adverse reactions and is safer than LMWH, exhibited better effects in the prevention and treatment of DVT after total knee arthroplasty in older adults.

Keyword

Apixaban; low molecular weight heparin; total knee arthroplasty; deep venous thrombosis

MeSH Terms

Adult*
Arthroplasty, Replacement, Knee*
Blood Platelets
Capillaries
Erythrocyte Aggregation
Fibrinogen
Heparin, Low-Molecular-Weight*
Humans
Incidence
Plasma
Prothrombin Time
Research Subjects
Thromboplastin
Venous Thrombosis*
Viscosity
Fibrinogen
Heparin, Low-Molecular-Weight
Thromboplastin

Figure

• 

  Fig. 1 Comparison of the incidence of DVT between the study groups. Compared with the LMWH group, *p<0.05. LMWH, low molecular weight heparin; DVT, deep venous thrombosis.

• 

  Fig. 2 Comparison of APTT, PT, PLT, and FIB indexes between the study groups. Compared with before surgery within the same group, *p<0.05; compared with the LMWH group, †p<0.05. APTT, activated partial thromboplastin time; PT, prothrombin time; PLT, platelets; FIB, fibrinogen; LMWH, low molecular weight heparin.

• 

  Fig. 3 Comparison of capillary plasma viscosity at the end of treatment between the study groups. Compared with the same group before intervention, *p<0.05; compared with the LMWH group after intervention, †p<0.05. LMWH, low molecular weight heparin.

• 

  Fig. 4 Comparison of erythrocyte aggregation at the end of treatment between the study groups. Compared with the same group before intervention, *p<0.05; compared with the LMWH group after intervention, †p<0.05. LMWH, low molecular weight heparin.

• 

  Fig. 5 Comparison of the postoperative drainage volume and the incidence of bleeding events between the study groups. Compared with the LMWH group, *p<0.05. LMWH, low molecular weight heparin.

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