Aspirin versus rivaroxaban in postoperative bleeding after total knee arthroplasty: a retrospective case-matched study

  • Varah YuenyongviwatEmail author
  • Pakjai Tuntarattanapong
  • Chaiwat Chuaychoosakoon
  • Chavalit Iemsaengchairat
  • Khanin Iamthanaporn
  • Theerawit Hongnaparak
Original Article • KNEE - ARTHROPLASTY



Venous thromboembolic disease (VTE) is a complication not uncommon following total knee arthroplasty. Postoperative bleeding-related complications are a concern in many guidelines. The authors aimed to compare the amount of postoperative drainage from closed suction drainage, transfusion rate, and postoperative complications between aspirin and rivaroxaban as VTE prophylaxes after total knee arthroplasty.


This study was a retrospective case-matched study of 155 patients. The data were collected between 2008 and 2015 from patients who had total knee arthroplasty using aspirin or rivaroxaban as the VTE prophylaxis. Seventy-nine patients received aspirin, and 76 patients received rivaroxaban. A single surgeon operated on all patients with the same surgical technique and patient care protocol.


The total closed suction drainage outputs at 48 h were not significantly different between the aspirin and rivaroxaban groups (p = 0.10). Eighteen percent of patients in the aspirin group and 25% of patients in the rivaroxaban group received blood transfusions (p = 0.37). There were no bleeding-related complications or VTE in either group.


Aspirin and rivaroxaban were effective and safe as VTE chemoprophylaxis in total knee arthroplasty.


Total knee replacement Aspirin Rivaroxaban VTE 



Venous thromboembolic disease


Body mass index (BMI)

ASA classification

The American Society of Anesthesiologists classification



The authors wish to thank Glenn Shingledecker for his assistance in proofreading the English of this report.

Authors’ contributions

VY designed the study and performed the analysis and manuscript preparation; TH designed the study and performed the data analysis; PT, CC, and CI collected data; KI designed the study and reviewed the manuscript. All authors read and approved the final manuscript.


Funding for this research was provided by the Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand (Grant No. 58-261-11-1).

Compliance with ethical standards

Conflict of interests

The authors declare that they have no competing interests.

Ethics approval

This study was approved by the Ethics Committee and Institutional Review Board of the Faculty of Medicine, Prince of Songkla University (EC 58-261-11-1).

Informed consent

Consent was waived by the ethics committee. The hospital gave permission to extract information from the database.

Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.


  1. 1.
    Leskinen J, Eskelinen A, Huhtala H, Paavolainen P, Remes V (2012) The incidence of knee arthroplasty for primary osteoarthritis grows rapidly among baby boomers: a population-based study in Finland. Arthritis Rheum 64(2):423–428CrossRefGoogle Scholar
  2. 2.
    Lee DK, Kim HJ, Lee DH (2016) Incidence of deep vein thrombosis and venous thromboembolism following TKA in rheumatoid arthritis versus osteoarthritis: a meta-analysis. PLoS ONE 11(12):e0166844CrossRefGoogle Scholar
  3. 3.
    Januel JM, Chen G, Ruffieux C, Quan H, Douketis JD, Crowther MA, Colin C, Ghali WA, Burnand B, IMECCHI Group (2012) Symptomatic in-hospital deep vein thrombosis and pulmonary embolism following hip and knee arthroplasty among patients receiving recommended prophylaxis: a systematic review. JAMA 307(3):294–303CrossRefGoogle Scholar
  4. 4.
    Lachiewicz PF (2009) Comparison of ACCP and AAOS guidelines for VTE prophylaxis after total hip and total knee arthroplasty. Orthopedics 32(12 Suppl):74–78CrossRefGoogle Scholar
  5. 5.
    Colwell CW (2009) The ACCP guidelines for thromboprophylaxis in total hip and knee arthroplasty. Orthopedics 32(12 Suppl):67–73CrossRefGoogle Scholar
  6. 6.
    Nikolaou VS, Desy NM, Bergeron SG, Antoniou J (2011) Total knee replacement and chemical thromboprophylaxis: current evidence. Curr Vasc Pharmacol 9(1):33–41CrossRefGoogle Scholar
  7. 7.
    Budhiparama NC, Abdel MP, Ifran NN, Parratte S (2014) Venous thromboembolism (VTE) prophylaxis for hip and knee arthroplasty: changing trends. Curr Rev Musculoskelet Med 7(2):108–116CrossRefGoogle Scholar
  8. 8.
    Mont MA, Jacobs JJ (2011) AAOS clinical practice guideline: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. J Am Acad Orthop Surg 19(12):777–778CrossRefGoogle Scholar
  9. 9.
    An VV, Phan K, Levy YD, Bruce WJ (2016) Aspirin as thromboprophylaxis in hip and knee arthroplasty: a systematic review and meta-analysis. J Arthroplasty 31(11):2608–2616CrossRefGoogle Scholar
  10. 10.
    Wilson DG, Poole WE, Chauhan SK, Rogers BA (2016) Systematic review of aspirin for thromboprophylaxis in modern elective total hip and knee arthroplasty. Bone Joint J 98-B(8):1056–1061CrossRefGoogle Scholar
  11. 11.
    Yoshida Rde A, Yoshida WB, Maffei FH, El Dib R, Nunes R, Rollo HA (2013) Systematic review of randomized controlled trials of new anticoagulants for venous thromboembolism prophylaxis in major orthopedic surgeries, compared with enoxaparin. Ann Vasc Surg 27(3):355–369CrossRefGoogle Scholar
  12. 12.
    Anderson DR, Dunbar M, Murnaghan J, Kahn SR, Gross P, Forsythe M, Pelet S, Fisher W, Belzile E, Dolan S, Crowther M, Bohm E, MacDonald SJ, Gofton W, Kim P, Zukor D, Pleasance S, Andreou P, Doucette S, Theriault C, Abianui A, Carrier M, Kovacs MJ, Rodger MA, Coyle D, Wells PS, Vendittoli PA (2018) Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty. N Engl J Med 378(8):699–707CrossRefGoogle Scholar
  13. 13.
    Jacobs JJ, Mont MA, Bozic KJ, Della Valle CJ, Goodman SB, Lewis CG, Yates AC Jr, Boggio LN, Watters WC III, Turkelson CM, Wies JL, Sluka P, Hitchcock K (2012) American Academy of Orthopaedic Surgeons clinical practice guideline on: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. J Bone Joint Surg Am 94:746–747CrossRefGoogle Scholar
  14. 14.
    Mostafavi Tabatabaee R, Rasouli MR, Maltenfort MG, Parvizi J (2015) Cost-effective prophylaxis against venous thromboembolism after total joint arthroplasty: warfarin versus aspirin. J Arthroplasty 30(2):159–164CrossRefGoogle Scholar
  15. 15.
    Atkins RM (2010) NICE and venous thromboembolism. J Bone Joint Surg Br 92(5):609–610CrossRefGoogle Scholar
  16. 16.
    Lieberman JR, Pensak MJ (2013) Prevention of venous thromboembolic disease after total hip and knee arthroplasty. J Bone Joint Surg Am 95(19):1801–1811CrossRefGoogle Scholar
  17. 17.
    Colleoni JL, Ribeiro FN, Mos PAC, Reis JP, Oliveira HR, Miura BK (2017) Venous thromboembolism prophylaxis after total knee arthroplasty (TKA): aspirin vs. rivaroxaban. Rev Bras Ortop 53(1):22–27CrossRefGoogle Scholar
  18. 18.
    Bala A, Huddleston JI 3rd, Goodman SB, Maloney WJ, Amanatullah DF (2017) Venous thromboembolism prophylaxis after TKA: aspirin, warfarin, enoxaparin, or factor Xa inhibitors? Clin Orthop Relat Res 475(9):2205–2213CrossRefGoogle Scholar
  19. 19.
    Zou Y, Tian S, Wang Y, Sun K (2014) Administering aspirin, rivaroxaban and low-molecular-weight heparin to prevent deep venous thrombosis after total knee arthroplasty. Blood Coagul Fibrinolysis 25(7):660–664CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopedics, Faculty of MedicinePrince of Songkla UniversityHat YaiThailand
  2. 2.Department of OrthopedicsRatchaburi HospitalRatchaburiThailand

Personalised recommendations