Venous thromboembolic disease prophylaxis in elective hip and knee replacement surgery

Information for adult patients admitted following elective hip or knee replacement surgery, to reduce the risk of venous thromboembolism (VTE) and who have been prescribed rivaroxaban to prevent the development of a deep vein thrombosis (DVT).

The aim of the leaflet is to provide information about rivaroxaban on discharge.

Introduction

This leaflet is about reducing the risk of blood clots occurring in patients admitted to hospital for elective hip and knee replacement surgery. Patients who have undergone hip or knee replacement surgery are at high risk of thromboembolic complications, but effective methods of minimizing this risk are available.

What is VTE (venous thromboembolism)?

VTE is where a blood clot (called a thrombus) forms in a vein. The most common form is a blood clot in the deep veins in the legs known as a deep vein thrombosis or DVT. This can happen when you are immobile for a period of time and slow moving blood collects in one area leading to the formation of a clot. If the blood clot then dislodges and travels in the blood, it is known as an embolism. There is a risk that the blood clot may dislodge and travel to the lung leading to a more serious complication called pulmonary embolism (PE) which can be life-threatening.

Rivaroxaban tablets to prevent deep vein thrombosis

The medication helps to reduce the development of a blood clot in the veins by increasing the time it takes for your blood to clot.

After hip replacement surgery: on discharge continue taking treatment for five weeks from the operation date.

After knee replacement surgery: on discharge continue taking treatment for two weeks from the operation date.

• You should take rivaroxaban 10mg (one tablet) once daily.
• It should be swallowed whole with water. It can be taken with or after food.
• You should take the medication at the same time each day.
• If you accidentally take more medication than you should, let your GP know as soon as possible so they can assess your risk of bleeding.
• If you miss a dose of the medication you should take it as soon as you remember. DO NOT take more than one dose in a single day. Take your next dose the following day at the usual time.
• The medication should be stored at room temperature and out of reach of children.
• You will be given a full supply of rivaroxaban from the hospital.

There is a very low risk of developing an adverse reaction to the medication but we would like you to be aware of the following:

Potential side effects from the medication (rivaroxaban tablets)

The most common side effects are indigestion and/or minor bruising. You may also experience minor bleeding such as from your nose, mouth or gums (when brushing your teeth), in your urine and from the vagina (such as heavier bleeding during your period). These effects should settle on their own. Consult your GP if symptoms persist for prolonged periods.

With rivaroxaban you may experience indigestion/nausea: try taking your medication after food. If symptoms persist consult your GP.

Diarrhoea/loose stools: Consult your GP.

Minor bruising/ minor bleeding: Consult your GP or NHS 111

Serious side-effects

The most serious side effects of anticoagulant therapy are serious bleeding or bruising.

Do not take your medication and seek medical advice immediately by attending your Emergency Department or calling 999, if you experience any of the following symptoms:

• vomiting or coughing up blood
• if you suffer a major injury or are unable to stop bleeding
• if you have a fall or injure yourself while on this treatment, especially if you hit your head
• prolonged nose bleeds (more than 10 minutes)
• pass significant amount of blood in your urine (pink or brown in colour)
• passing significant amount of blood in your stool or poo (red or black in colour)
• unexplained severe dizziness or weakness
• sudden severe headache
• unusual, severe or spontaneous bruising
• Severe or prolonged menstrual bleeding for women
• Exceptional tiredness or paleness

If you cut yourself, apply firm pressure to the site for at least five minutes using a clean, dry dressing. If the bleeding does not stop within 10 minutes, go to your Emergency Department.

What can affect the control of your anticoagulation?

It is advisable to avoid a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs), unless specifically prescribed for you by a doctor who is aware you are taking an anticoagulant. NSAIDs are often used as painkillers and examples include aspirin, ibuprofen, diclofenac and naproxen.

• Paracetamol is a safe medicine to use as pain relief, if needed, alongside your anticoagulant.
• If you purchase any over-the-counter medication, vitamins, supplements or herbal remedies, consult your pharmacist first to ensure these are safe to take with your anticoagulant.
• How well your anticoagulant works is not affected by alcohol. If you drink alcohol, drink in moderation and within recommended guidelines.
• You should try to eat a healthy diet.

Who must you tell that you are taking rivaroxaban?

Please be sure to speak with:

• your doctor or health care professional who are prescribing your medicines that you currently take rivaroxaban. They will advise you which medicines are safe to take with rivaroxaban.
• your pharmacist if you are planning to buy any additional over-the-counter medicines, vitamins, supplements or herbal remedies
• any health care professional involved in your medical care during the treatment period. ie dentist

You should carry your anticoagulant alert card with you at all times while on treatment.

References/sources of evidence

NICE Clinical Guideline 89. Venous thromboembolism in over 16s reducing the risk hospital-acquired deep vein thrombosis and pulmonary embolism) August 2019