Prothrombin time-international normalized ratio is a useful marker for edoxaban efficacy in preventing venous thromboembolism after total knee arthroplasty

Abstract

Background: Deep vein thrombosis (DVT) is one of the main complications following total knee arthroplasty (TKA). In this study, oral administration of 15 mg edoxaban (a factor Xa inhibitor) once daily for 14 days efficiently prevented the incidence of DVT. Our hypothesis was that prothrombin time-international normalized ratio (PT-INR) on the third postoperative day could predict the incidence of DVT following TKA.

Methods: In this study, 286 subjects were enrolled and divided into two groups according to the presence or absence of DVT. Several variables [age, body mass index, postoperative D-dimer level, PT-INR, and functional recovery findings (standing)] were analysed to determine the predictors of DVT, and for DVT diagnosis, ultrasonography was performed for seven days after surgery.

Results: The PT-INR levels were significantly higher in the group that did not develop DVT (p = 0.01). Further analysis with logistic regression analysis and receiver operating characteristic curve was performed. The PT-INR on the third postoperative day was an independent factor of the incidence of DVT (odds ratio 0.210; p = 0.035). The cut-off PT-INR was calculated to be 1.425.

Conclusion: PT-INR level is a useful marker in determining whether 15 mg edoxaban administration can prevent DVT after TKA. It is suggested that increment of edoxaban to control PT-INR over the cut-off point might prevent the incidence of DVT.

Keywords: Deep vein thrombosis (DVT); Edoxaban; Functional recovery; Prothrombin time-international normalized ratio (PT-INR); Total knee arthroplasty.