Why the study?
Rivaroxaban is increasingly used after hip or knee arthroplasty, but postoperative bleeding can occur at surgical or regional anesthesia sites, necessitating careful use.
Highlights the risk of severe bleeding complications, such as epidural hematoma, when using rivaroxaban in the perioperative setting of regional anesthesia and orthopedic surgery.
Supports caution with rivaroxaban around regional anesthesia; single case leaves open optimal perioperative protocols.
Direct oral anticoagulants (DOACs), including anti-IIa (dabigatran, pradaxa) and anti-Xa (rivaroxaban, apixaban, edoxaban), are the most recently introduced anticoagulants. Compared to warfarin, DOAC has a faster onset, predictable therapeutic range, shorter half-life [1], and relatively lesser interaction with other medicines and foods. It can be easily administered in a fixed dose as an oral preparation without blood coagulation monitoring [2]. Therefore, there has been a surge in its use in patients with non-valvular atrial fibrillation and in recurrent venous thromboembolism. Recently, rivaroxaban has proved effective in preventing symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) after hip or knee arthroplasty and its use for this purpose has shown an increased trend [3]. However, since postoperative bleeding may occur at the surgical site or at the site of regional anesthesia, careful use is necessary with respect to each individual patient and the usage guidelines.
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Shin et al. (2019) studied this question.
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