Effectiveness of tranexamic acid combined with different antithrombotic agents in total knee arthroplasty：a prospective randomized study

Effectiveness of tranexamic acid combined with different antithrombotic agents in total knee arthroplasty：a prospective randomized study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of tranexamic acid combined with different antithrombotic agents in total knee arthroplasty：a prospective randomized study Li-Bo Zhou, Chao-Chao Wang, Lan-Tao Zhang, Tao Wu, Guo-Qiu Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1909864/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Jan, 2023 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted 9 You are reading this latest preprint version Abstract Background: To observe the effect of tranexamic acid (TXA) in combination with different antithrombotic agents in patients after initial unilateral total knee arthroplasty (TKA). Methods: One hundred and eighty patients with initial unilateral TKA from October 2020 to December 2021 were selected, all of whom were given intraoperative intravenous 60 mg/kg TXA and were divided into the rivaroxaban group, the dalteparin sodium group, and the aspirin group according to the application of antithrombotic drugs, with 60 cases each. The rivaroxaban group received 10 mg of oral Rivaroxaban 12 h after surgery, the dalteparin sodium group received 2500 U of subcutaneous dalteparin sodium, and the aspirin group received 100 mg of oral aspirin once daily for four weeks. The incidence of various hematological indices, transfusion rate, blood loss, and complications (bleeding complications and thrombotic complications) were observed in the three groups before and after treatment. Results: The hemoglobin levels were significantly lower in the Rivaroxaban, dalteparin sodium, and aspirin groups on days 1, 3, and 5 after treatment compared with those before treatment (P<0.05). The hemoglobin level was higher in the aspirin group than in the rivaroxaban and dalteparin sodium groups on days 1, 3, and 5 after treatment (P<0.05) and in the rivaroxaban group than in the dalteparin sodium group (P<0.05). When comparing the transfusion rates of the three groups, the transfusion rate in the dalteparin sodium group (20.0%) was significantly higher than that in the rivaroxaban group (6.7%) and the aspirin group (5.0%), with P<0.05. When comparing the post-treatment drainage and total blood loss in the three groups, the post-treatment drainage and total blood loss in the aspirin group were significantly lower than those in the rivaroxaban and dalteparin sodium groups (P<0.05), and the post-treatment drainage and total blood loss in the rivaroxaban group were significantly lower than those in the rivaroxaban and dalteparin sodium groups (P<0.05). Total blood loss was significantly lower in the rivaroxaban group than in the dalteparin sodium group (P<0.05). The incidence of bleeding complications in the three groups was significantly higher in the rivaroxaban group (26.7%) than in the dalteparin sodium group (10.0%) and the aspirin group (8.3%), with P0.05). Conclusion: Aspirin, Rivaroxaban, and dalteparin sodium effectively prevent venous thromboembolism after total knee arthroplasty. The additional benefit of aspirin in reducing total blood loss, transfusion rates, and bleeding complication rates supports the use of aspirin as a suitable alternative to other anticoagulants to prevent thrombosis after total knee arthroplasty in low-risk patients. Trial registration: The trial was registered in the Chinese Clinical Trial Registry (ChiCTR2200060169). Registered date: 21/05/2022 total knee arthroplasty Tranexamic acid Rivaroxaban Low molecular weight heparins aspirin venous thromboembolism Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 04 Jan, 2023 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted Editorial decision: Major revision 11 Nov, 2022 Reviews received at journal 26 Oct, 2022 Reviewers agreed at journal 16 Oct, 2022 Reviewers agreed at journal 16 Oct, 2022 Reviewers invited by journal 13 Oct, 2022 Editor assigned by journal 13 Oct, 2022 Editor invited by journal 12 Sep, 2022 Submission checks completed at journal 12 Sep, 2022 First submitted to journal 29 Jul, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1909864","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":136083631,"identity":"0a537eb7-6045-4f06-8e8a-c36466caeaa5","order_by":0,"name":"Li-Bo Zhou","email":"","orcid":"","institution":"Qinghai University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Li-Bo","middleName":"","lastName":"Zhou","suffix":""},{"id":136083632,"identity":"81ede08a-b24f-49c3-b245-2440d10af008","order_by":1,"name":"Chao-Chao Wang","email":"","orcid":"","institution":"Affiliated Hospital of Qinghai University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chao-Chao","middleName":"","lastName":"Wang","suffix":""},{"id":136083633,"identity":"8e9db8fe-4fd1-481c-8f64-2543df8542a3","order_by":2,"name":"Lan-Tao Zhang","email":"","orcid":"","institution":"Affiliated Hospital of Qinghai University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lan-Tao","middleName":"","lastName":"Zhang","suffix":""},{"id":136083634,"identity":"95938182-73bf-43cc-8014-b630fbbde2bb","order_by":3,"name":"Tao Wu","email":"","orcid":"","institution":"Affiliated Hospital of Qinghai University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Wu","suffix":""},{"id":136083635,"identity":"ec49f4d7-9988-4cc9-87a2-add47f0794c6","order_by":4,"name":"Guo-Qiu Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYBAC+/7m4x8SDCTk7NsbiNRiIHEsjeFDgY2xAc8BYrUw5JgxzviQlrhBIoFILeYMB8we8xgcZtwu+XjjDYYam2iCWiybG9KNgVqYLWenFVswHEvLbSCo58CBA9JALWwMt3PMJBgbDhOjJbEBpIWH4eYZIrUYHEhmk5xhkCZhcIOHSC2SM44xG3wwsDGQ7AH6JYEYv/Dz9398kPBHor6f/fDGGx9qbIjwC7IjiY4aJC2k6hgFo2AUjIKRAQDmDUJs9cnPUgAAAABJRU5ErkJggg==","orcid":"","institution":"Affiliated Hospital of Qinghai University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Guo-Qiu","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2022-07-29 15:59:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1909864/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1909864/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12891-022-06117-8","type":"published","date":"2023-01-04T18:14:38+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":26472635,"identity":"9ba04a02-564c-446f-92f5-17a91f72ef7d","added_by":"auto","created_at":"2022-09-14 21:04:46","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":354171,"visible":true,"origin":"","legend":"","description":"","filename":"Effectivenessoftranexamicacidcombinedwithdifferentantithromboticagentsintotalkneearthroplastyaprospectiverandomizedstudy.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1909864/v1_covered.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effectiveness of tranexamic acid combined with different antithrombotic agents in total knee arthroplasty：a prospective randomized study","fulltext":[{"header":"Full Text","content":"This preprint is available for \u003ca href='/article/rs-1909864/latest.pdf' target='_blank'\u003edownload as a PDF\u003c/a\u003e."}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"total knee arthroplasty, Tranexamic acid, Rivaroxaban, Low molecular weight heparins, aspirin, venous thromboembolism","lastPublishedDoi":"10.21203/rs.3.rs-1909864/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1909864/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: To observe the effect of tranexamic acid (TXA) in combination with different antithrombotic agents in patients after initial unilateral total knee arthroplasty (TKA).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethods: One hundred and eighty patients with initial unilateral TKA from October 2020 to December 2021 were selected, all of whom were given intraoperative intravenous 60 mg/kg TXA and were divided into the rivaroxaban group, the dalteparin sodium group, and the aspirin group according to the application of antithrombotic drugs, with 60 cases each. The rivaroxaban group received 10 mg of oral Rivaroxaban 12 h after surgery, the dalteparin sodium group received 2500 U of subcutaneous dalteparin sodium, and the aspirin group received 100 mg of oral aspirin once daily for four weeks. The incidence of various hematological indices, transfusion rate, blood loss, and complications (bleeding complications and thrombotic complications) were observed in the three groups before and after treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: The hemoglobin levels were significantly lower in the Rivaroxaban, dalteparin sodium, and aspirin groups on days 1, 3, and 5 after treatment compared with those before treatment (P\u0026lt;0.05). The hemoglobin level was higher in the aspirin group than in the rivaroxaban and dalteparin sodium groups on days 1, 3, and 5 after treatment (P\u0026lt;0.05) and in the rivaroxaban group than in the dalteparin sodium group (P\u0026lt;0.05). When comparing the transfusion rates of the three groups, the transfusion rate in the dalteparin sodium group (20.0%) was significantly higher than that in the rivaroxaban group (6.7%) and the aspirin group (5.0%), with P\u0026lt;0.05. When comparing the post-treatment drainage and total blood loss in the three groups, the post-treatment drainage and total blood loss in the aspirin group were significantly lower than those in the rivaroxaban and dalteparin sodium groups (P\u0026lt;0.05), and the post-treatment drainage and total blood loss in the rivaroxaban group were significantly lower than those in the rivaroxaban and dalteparin sodium groups (P\u0026lt;0.05). Total blood loss was significantly lower in the rivaroxaban group than in the dalteparin sodium group (P\u0026lt;0.05). The incidence of bleeding complications in the three groups was significantly higher in the rivaroxaban group (26.7%) than in the dalteparin sodium group (10.0%) and the aspirin group (8.3%), with P\u0026lt;0.05. There was no significant difference in the incidence of thrombotic complications between the three groups of patients (P\u0026gt;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: Aspirin, Rivaroxaban, and dalteparin sodium effectively prevent venous thromboembolism after total knee arthroplasty. The additional benefit of aspirin in reducing total blood loss, transfusion rates, and bleeding complication rates supports the use of aspirin as a suitable alternative to other anticoagulants to prevent thrombosis after total knee arthroplasty in low-risk patients.\u003c/p\u003e\n\u003cp\u003eTrial registration: The trial was registered in the Chinese Clinical Trial Registry (ChiCTR2200060169). Registered date: 21/05/2022\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Effectiveness of tranexamic acid combined with different antithrombotic agents in total knee arthroplasty：a prospective randomized study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-09-14 21:04:36","doi":"10.21203/rs.3.rs-1909864/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-11-11T05:25:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-10-26T11:56:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4849a1c4-28d8-4f31-9b91-ca0761d8a36a","date":"2022-10-16T18:32:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7d025dd7-35ab-4221-aa55-7bf3b3033b8f","date":"2022-10-16T10:20:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-10-13T10:44:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-10-13T09:13:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-09-12T16:13:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-09-12T16:08:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2022-07-29T15:49:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"305cc24e-7ea4-4596-bf52-3d7f4ea2a9ab","owner":[],"postedDate":"September 14th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T18:18:49+00:00","versionOfRecord":{"articleIdentity":"rs-1909864","link":"https://doi.org/10.1186/s12891-022-06117-8","journal":{"identity":"bmc-musculoskeletal-disorders","isVorOnly":false,"title":"BMC Musculoskeletal Disorders"},"publishedOn":"2023-01-04 18:14:38","publishedOnDateReadable":"January 4th, 2023"},"versionCreatedAt":"2022-09-14 21:04:36","video":"","vorDoi":"10.1186/s12891-022-06117-8","vorDoiUrl":"https://doi.org/10.1186/s12891-022-06117-8","workflowStages":[]},"version":"v1","identity":"rs-1909864","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1909864","identity":"rs-1909864","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}