Comparison of the Therapeutic Effect of Different Anticoagulation Regimens after Total Hip Arthroplasty based on ERAS

Objective To compare the efficacy of low molecular weight heparin (LMWH), fondaparinux sodium (FPX), and rivaroxaban after total hip arthroplasty (THA) under Enhanced Recovery After Surgery (ERAS). Method The clinical data of patients who underwent primary THA due to hip joint disease in Ningxia Medical University General Hospital from October 2020 to June 2022 were retrospectively collected and analyzed. According to different anticoagulant methods, patients were divided into LMWH group (42 cases), FPX group (24 cases), and Rivaroxaban group (39 cases). Detect and record changes of blood coagulation-related factors, D-dimer, platelet (PLT) changes, blood routine, blood loss, lower limb vein thrombosis (DVT), pulmonary embolism, and allogeneic blood transfusion in the three groups perioperatively. Result There was no statistical significance in the comparison of coagulation indexes before the operation among the three groups (P > 0.05), but there was statistical significance in the comparison of PT and INR levels at 3 days after the operation (P < 0.05). There was a statistically significant difference between the Hb before operation and the Hct 3 days after operation in the three groups (P < 0.05). The postoperative drainage volume and overt blood loss of the three groups were statistically significant (P < 0.05), but there were no significant differences in intraoperative blood loss, hidden blood loss, and total blood loss (P > 0.05). There was no significant difference in VAS score, blood transfusion rate, and DVT incidence rate among the three groups before and 3 days after surgery (P > 0.05), and the treatment cost ratio of patients in LMWH group was lower than that of FPX group and Rivaroxaban group, the difference was statistically significant (P < 0.05). Conclusion Based on the ERAS concept, the use of LMWH, FPX, and Rivaroxaban after THA can effectively and safely prevent the occurrence of VTE and has no significant difference in postoperative pain, perioperative blood loss, and coagulation function. However, Rivaroxaban can be taken orally directly and has more advantages in pharmacological effects, while LMWH is cheaper and more economical.