The Clinical Study Of Distinctive Sequential Anticoagulation Schemes To Prevent Venous Thromboembolism After Total Knee Arthroplasty

Objective:Compare the safety and efficacy of low molecular weight heparin/apixaban and fondaparinux/apixaban in the prevention of venous thromboembolism(VTE)after total knee arthroplasty(TKA),and explore a better anticoagulation strategy for them.Methods:In this study,146 patients receiving unilateral TKA in our hospital from October 2020 to October 2021 who comformed to the inclusion and exclusion criteria were divided into two groups according to the different sequential anticoagulation schemes after operation: low molecular weight heparin/apixaban group(n = 75)and fondaparinux/apixaban group(n = 71).Perform a statistical analysis of the data which includes general data(sex,age,body mass index,operation time),safety indicators(bleeding events,postoperative drainage,hemoglobin,activated partial thromboplastin time,prothrombin time,fibrinogen,platelets,alanine aminotransferase,creatinine,postoperative hospital stay)and effectiveness indicators(D-dimer,the difference of the circumference of the calf 10 cm below the patella of the affected limb before and after operation,Thrombus events),for the purpose of comparing the distinctions between the two groups.Result:1、In the comparison of general data,there was no statistically significant distinction in sex,age,body mass index and operation time between the two groups(P>0.05).2 、 In the comparison of safety indicators,there was no statistically significant distinction in bleeding events and postoperative drainage between the two groups(P>0.05).There was no statistically significant distinction in hemoglobin and activated partial thromboplastin time between the two groups before operation,on the 1st day after operation and on the day of discharge(P>0.05).There was no statistically significant distinction in prothrombin time between the two groups before operation and on the day of discharge(P>0.05).On the 1st day after operation,the prothrombin time in low molecular weight heparin/apixaban group was slightly shorter than that in fondaparinux/apixaban group,and the difference was statistically significant(P<0.05).There was no statistically significant distinction in fibrinogen between the two groups before operation and on the day of discharge(P>0.05).On the 1st day after operation,the level of fibrinogen in fondaparinux/apixaban group was slightly lower than that in low molecular weight heparin/apixaban group,and the difference was statistically significant(P<0.05);There was no statistically significant distinction in platelets,alanine aminotransferase and creatinine between the two groups before operation,on the 1st day after operation and on the day of discharge(P>0.05);there was no statistically significant distinction in postoperative hospital stay between the two groups(P>0.05).3、 In the comparison of effectiveness indicators,there was no statistically significant distinction in D-dimer before operation,on the1 st day after operation and on the day of discharge(P>0.05).There was no statistically significant distinction in the difference of the circumference of the calf 10 cm below the patella of the affected limb between the 3rd day after operation,the 6th day after operation,the 12 th day after operation and before operation(P>0.05).The incidence of thrombus in fondaparinux/apixaban group was significantly lower than that in low molecular weight heparin/apixaban group(P<0.05).Conclusion:The efficacy of sequential anticoagulation schemes of fondaparinux/apixaban in the prevention of VTE after TKA is better than that of low molecular weight heparin/apixaban,meanwhile the safety of the two schemes is similar.Therefore,the sequential anticoagulant scheme of fondaparinux/apexaban is a more suitable anticoagulant scheme for patients after TKA to select.