Key result
A half-dose Factor Xa inhibitor protocol following total joint arthroplasty did not significantly reduce significant bleeding events compared to a full-dose protocol (aOR 0.66, p=0.424).
Why the study?
The relationship between postoperative factor Xa inhibitor dosing regimens and the occurrence of significant bleeding and venous thromboembolic events after total joint arthroplasty was not well established.
Does a half-dose postoperative factor Xa inhibitor regimen reduce significant bleeding compared to a full-dose regimen in patients undergoing total joint arthroplasty?
Cohort (n=332)
No
Does a half-dose postoperative factor Xa inhibitor regimen reduce significant bleeding compared to a full-dose regimen in patients undergoing total joint arthroplasty?
Odds Ratio: 0.66 (95% CI 0.24–1.83)
Absolute Event Rate: 6.1% vs 7.3%
p-value: p=0.424
A half-dose resumption strategy for factor Xa inhibitors after total joint arthroplasty showed comparable rates of bleeding and VTE to a full-dose strategy, suggesting it may be a viable conservative approach.
No difference in bleeding or VTE rates with half- vs full-dose FXaI resumption post-TJA; leaves open optimal regimen for chronic users pending prospective trials.
Introduction Factor Xa inhibitors (FXaI), a type of direct oral anticoagulant (DOAC), are medications used in patients at risk for, and after venous thromboembolic (VTE) events. The aim of this retrospective cohort study is to investigate the relationship between two postoperative FXaI dosing regimens and the occurrence of significant bleeding and VTE events following total joint arthroplasty (TJA). Methods This study included patients who underwent primary TJA and were preoperatively receiving apixaban or rivaroxaban. Group A included patients who resumed a half-dose FXaI for seven days postoperatively prior to resuming their preoperative dose. Group B resumed their preoperative dose the evening of surgery. The measured outcomes were significant bleeding or VTE events within 6 months of surgery. Results There were 332 patients included in this study; (Group A=98, (29.5%), Group B=234, (70.5%)). Group A experienced a lower number of significant bleeding events compared to Group B; however, this difference was not statistically significant (Group A: 6 (6.1%) vs Group B: 17 (7.3%), p=0.708.) Group B experienced a higher incidence of VTE compared to group B, however, the difference was not statistically significant (Group A: 2 (2.0%) vs Group B: 3 (1.3%), p=0.605). When adjusting for patient demographics, there was no statistically significant difference in bleeding (P=0.424) or VTE outcomes (P=0.774). Conclusion There was no statistically significant difference in postoperative bleeding and VTE events between patients who were restarted on a half-dose or full-dose regimen of apixaban or rivaroxaban following TJA.
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Raja et al. (2025) conducted a cohort in Postoperative joint replacement (total joint arthroplasty) (n=332). Half-dose Factor Xa inhibitor protocol vs. Full-dose Factor Xa inhibitor protocol (resumed preoperative dose on postoperative day 1) was evaluated on Significant bleeding events within 6 months postoperatively (aOR 0.66, 95% CI 0.24-1.83, p=0.424). A half-dose Factor Xa inhibitor protocol following total joint arthroplasty did not significantly reduce significant bleeding events compared to a full-dose protocol (aOR 0.66, p=0.424).
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