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Related Concept Videos

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Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
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During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Related Experiment Video

Updated: Jan 9, 2026

The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
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Delayed Administration of Apixaban, but Not Rivaroxaban, Reduces Transfusion Risk Without Increasing Thromboembolic

Sahil S Telang1, Matthew Lim1, Pranit Kumaran1

  • 1Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.

The Journal of Arthroplasty
|November 29, 2025
PubMed
Summary

Starting apixaban on postoperative day one after revision total hip arthroplasty reduces transfusion and acute anemia risks. For rivaroxaban, timing did not significantly impact bleeding or thromboembolic complications.

Keywords:
chemoprophylaxisdirect oral anticoagulantsrevision arthroplastyrevision total hip arthroplastytotal hip arthroplastyvenous thromboembolism

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Area of Science:

  • Orthopedic Surgery
  • Pharmacology
  • Thrombosis Medicine

Background:

  • Optimal timing for direct oral anticoagulants (DOACs) in venous thromboembolism (VTE) prophylaxis post-revision total hip arthroplasty (rTHA) remains unclear.
  • This study investigated VTE and bleeding complication rates comparing early (postoperative day [POD] zero) versus delayed (POD one) initiation of apixaban or rivaroxaban.

Purpose of the Study:

  • To compare the safety and efficacy of initiating apixaban and rivaroxaban on POD zero versus POD one for VTE prophylaxis after rTHA.
  • To determine the optimal timing for DOAC initiation to minimize bleeding and thromboembolic events.

Main Methods:

  • A national healthcare database (2016-2023) identified patients undergoing aseptic rTHA.
  • Patients receiving apixaban or rivaroxaban on POD zero were compared to those on POD one.
  • Primary outcomes included 90-day rates of bleeding (anemia, hematoma, hemorrhage, transfusion) and thromboembolic complications (DVT, PE, stroke, MI). Multivariable regression analysis was performed.

Main Results:

  • Apixaban initiated on POD one was linked to lower odds of transfusion (aOR: 0.702) and acute anemia (aOR: 0.890) compared to POD zero initiation.
  • Patients on POD one apixaban had similar VTE risks but reduced myocardial infarction odds (aOR: 0.338).
  • Rivaroxaban administration timing (POD zero vs. one) showed no significant differences in bleeding, transfusion, or VTE complications.

Conclusions:

  • Initiating apixaban on POD one for rTHA patients is associated with reduced bleeding complications, specifically lower transfusion needs, without increasing VTE risk.
  • The timing of rivaroxaban initiation did not significantly affect postoperative bleeding or thromboembolic complication rates in this patient cohort.