The clinical impact of edoxaban for the patients with postoperative anemia after total hip arthroplasty

  • Yasuhisa Izushi
  • Naofumi Shiota
  • Tomonori Tetsunaga
  • Kenichi Shimada
  • Takashi Egawa
  • Tsukasa Kiuchi
  • Toru Sato
  • Ritsugi Takuma
  • Yoichiro TakamiEmail author
Original Article • HIP - ARTHROPLASTY



Postoperative anemia is a common complication after total hip arthroplasty (THA). However, the effect of edoxaban on postoperative anemia after THA remains unclear. Here, we retrospectively evaluated the clinical assessment of postoperative anemia and the associated changes of coagulation parameters in patients undergoing thromboprophylaxis with edoxaban compared with fondaparinux as a conventional anticoagulant thromboprophylactic agent after THA.


One hundred and forty-nine patients who underwent THA from July 2010 to June 2012 were divided into two groups, according to whether they were operated on before or after the approval of edoxaban: the fondaparinux group (Group F: 86 patients) and the edoxaban group (Group E: 63 patients). The frequency of postoperative anemia and blood coagulation values were investigated.


Postoperative anemia developed more frequently in Group E than in Group F after surgery. However, the degree of postoperative anemia showed no significant difference between the groups. Meanwhile, prothrombin time (PT), prothrombin time-international normalized ratio (PT-INR), and activated partial thromboplastin time were markedly higher in patients with edoxaban-associated postoperative anemia, which showed an increased potential to predict the occurrence of postoperative anemia. Additionally, both PT and PT-INR in Group E were also correlated with the volume of estimated blood loss.


The frequency of postoperative anemia was increased in patients treated with edoxaban, compared to fondaparinux, after THA. Edoxaban thromboprophylaxis might, therefore, require more careful monitoring to prevent postoperative anemia. Additionally, particular prolongation of PT and PT-INR induced by edoxaban treatment might predict postoperative anemia.


Edoxaban Total hip arthroplasty Postoperative anemia Prothrombin time 



We thank Yusuke Ookura, Akimasa Yoshida, Kazuma Koga, Yuko Kuwada, Anna Ueno, Satomi Tani, Shunki Ishihara for helpful discussion and assistance with all our data analyses. Repeatedly, all of them helped with the data extraction from their respective database and ensured the high quality of the data by numerous quality checks.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

590_2018_2212_MOESM1_ESM.pptx (126 kb)
Supplementary material 1 (PPTX 126 kb)


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Yasuhisa Izushi
    • 1
    • 2
  • Naofumi Shiota
    • 3
  • Tomonori Tetsunaga
    • 4
  • Kenichi Shimada
    • 5
  • Takashi Egawa
    • 5
  • Tsukasa Kiuchi
    • 1
  • Toru Sato
    • 3
  • Ritsugi Takuma
    • 6
  • Yoichiro Takami
    • 5
    Email author
  1. 1.Department of PharmacyNational Hospital Organization Okayama Medical CenterOkayamaJapan
  2. 2.Department of PharmacologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
  3. 3.Department of Orthopaedic SurgeryNational Hospital Organization Okayama Medical CenterOkayamaJapan
  4. 4.Department of Orthopaedic SurgeryOkayama University HospitalOkayamaJapan
  5. 5.Pharmaceutical Care and Health Sciences, School of PharmacyShujitsu UniversityOkayamaJapan
  6. 6.Department of PharmacyShikoku Medical Center for Children and AdultsKagawaJapan

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