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Gastrointestinal disorders, bleeding and haematoma: 4 case reports In a retrospective study reviewing prospectively collected institutional data of patients, who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 01 February 2017 and 29 January 2019, four patients [ages and sexes not stated] were described, who developed gastric ulcer with upper gastrointestinal bleeding, erosive gastritis, incision site bleeding or haematoma following administration of aspirin, apixaban or rivaroxaban as venous thromboembolism prophylaxis at the time of THA or TKA [times to reactions onsets not stated; not all dosages, routes and outcomes stated]. Two out of the four patients received aspirin (low dose 81mg twice daily or high dose 325mg twice daily; one patient each). The patient, who received high dose aspirin as venous thromboembolism prophylaxis at the time of TKA, developed a gastric ulcer and upper gastrointestinal tract bleeding. The patient had history of alcohol abuse and gastric bypass surgery. The other patient, who received low dose of aspirin as venous thromboembolism prophylaxis at the time of THA, developed an expanding haematoma complicated by hypotension, immediately after the surgery. A CT angiogram did not reveal an active bleeding. Haematoma was stable following initiation of treatment with unspecified vasopressor. Out of the remaining two patients, one patient, who received oral apixaban as venous thromboembolism prophylaxis at the time of TKA, developed erosive gastritis, which resolved spontaneously. The other patient, who received oral rivaroxaban as venous thromboembolism prophylaxis at the time of TKA, presented with continuous blood drainage from the incision site one week following the surgery. The drainage did not stop with a negative pressure wound therapy dressing and compulsory bedrest in a knee immobiliser. Subsequently, the patient needed operative evacuation of haematoma with irrigation and debridement. Gold PA, et al. Can the Caprini score predict thromboembolism and guide pharmacologic prophylaxis after primary joint arthroplasty?. Journal of Orthopaedics 21: 345-349, 803506690 Sep-Oct 2020. Available from: URL: http://doi.org/10.1016/j.jor.2020.07.005

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Reactions 17 Oct 2020 No. 1826