Edoxaban Enhances Thromboprophylaxis by Physiotherapy After Total Knee Arthroplasty　― The Randomized Controlled ESCORT-TKA Trial ―

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  • Sueta Daisuke
    Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University
  • Kaikita Koichi
    Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University
  • Okamoto Nobukazu
    Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University
  • Yamabe Soichiro
    Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University
  • Ishii Masanobu
    Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University
  • Arima Yuichiro
    Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University
  • Ito Miwa
    Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University
  • Oimatsu Yu
    Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University
  • Mitsuse Tatsuro
    Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University
  • Iwashita Satomi
    Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University
  • Nakamura Eiichi
    Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University
  • Hokimoto Seiji
    Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University
  • Mizuta Hiroshi
    Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University
  • Ogawa Hisao
    Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University
  • Tsujita Kenichi
    Department of Cardiovascular Medicine, Faculty of Life Sciences, Kumamoto University
  • for the ESCORT-TKA Study Investigators

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<p>Background:The pharmacological advantage of combining physiotherapy with anticoagulants for the prevention of venous thromboembolism (VTE) after total knee arthroplasty (TKA) is not fully known. Herein we investigated the potential benefit of this combination therapy in patients undergoing TKA.</p><p>Methods and Results:The 38 patients were randomly assigned to a physiotherapy group (n=19) or a physiotherapy plus 30 mg/day edoxaban group (n=19). The occurrence of VTE was evaluated, as were serial changes in parameters measured by the Total Thrombus-formation Analysis System, a novel system for quantitatively analyzing thrombus formation using microchips with thrombogenic surfaces (collagen plus tissue factor, atheroma [AR]-chip). Combination therapy significantly reduced the incidence of VTE after TKA compared with monotherapy (P=0.038). The area under the curve (AUC) of thrombus formation for the AR-chip (AR10-AUC30) was significantly lower in the combination group (P=0.001) on Day 7 after TKA than before TKA, but no significant change was observed with monotherapy (P=0.809). In 13 VTE-positive patients, AR10-AUC30was significantly lower in the combination group (n=3) than in the monotherapy group (n=10) on Day 7 (P=0.045).</p><p>Conclusions:The combination of physiotherapy and edoxaban significantly reduced the incidence of VTE after TKA compared with physiotherapy alone. However, it is possible that VTE occurrence after TKA is not only associated with thrombogenicity, but also rheological factors.</p>

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  • Circulation Journal

    Circulation Journal 82 (2), 524-531, 2018

    一般社団法人 日本循環器学会

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