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Deep vein thrombosis incidence after sequential Low-molecular-weight heparin and Rivaroxaban versus no prophylaxis in posterior cruciate ligament avulsion fractures
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  • Published: 05 February 2026

Deep vein thrombosis incidence after sequential Low-molecular-weight heparin and Rivaroxaban versus no prophylaxis in posterior cruciate ligament avulsion fractures

  • Md Miftahul Mithu1,2,3,
  • Ting-Hua Wang3,
  • Jiazheng Huang2,
  • Huiqin Yang2,
  • Md Ariful Haque2,
  • Ying Xiong2,
  • Ronald Hartono4,
  • Haiqing Li5,
  • Jiayu Xiao2,
  • Zhengzong Yang2,
  • Jie Wang2,
  • Zhongxiong Wu2 &
  • …
  • Zhuoyuan Chen1,2 

Scientific Reports , Article number:  (2026) Cite this article

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Orthopaedics
  • Outcomes research

Abstract

The study aimed to compare the effectiveness of low-molecular-weight heparins (LMWH) followed by Rivaroxaban with no anticoagulant treatment in preventing deep vein thrombosis (DVT) after open reduction and internal fixation surgery (ORIF) for posterior cruciate ligament (PCL) avulsion fractures. This quasi-experimental study enrolled 37 patients with posterior cruciate ligament (PCL) avulsion fractures. Following surgery, four patients were excluded for not meeting the inclusion criteria, and the remaining 33 participants were allocated into Group A (n = 16) and Group B (n = 17). Surgical methods involved standard open reduction and internal fixation surgery (ORIF) protocols and anatomical alignment restoration using absorbable Bone Anchor Nails. Group A received prophylactic anticoagulation with LMWH followed by Rivaroxaban, while Group B did not received any anticoagulant. All patients received standard postoperative care included standardized rehabilitation protocols and monitoring for DVT using Color Doppler Ultrasound examinations. Patients underwent follow-up ultrasound examinations at 7 days and 1-month post-operation to assess DVT presence and condition. This comprehensive methodology allows for a thorough evaluation of the efficacy and safety of prophylactic anticoagulation in patients with PCL avulsion fractures and complications were observed between the two groups. The study included 33 patients who had undergone surgical treatment for PCL avulsion fractures, divided into Group A (LMWH followed by Rivaroxaban) and Group B (No anticoagulant treatment). No statistically significant differences were observed in the demographic and preoperative laboratory data between Group A (LMWH followed by Rivaroxaban) and Group B (no anticoagulation). Postoperatively, ESR, CRP, ALB, and Hb levels showed no significant differences between the two groups (P > 0.05). At 1 month postoperatively, the overall incidence of DVT was significantly lower in Group A (6.25%) than in Group B (35.29%) (P = 0.041). The percentage of DVT-free patients was 93.75% in Group A and 64.71% in Group B (P = 0.041). During the first seven postoperative days, the DVT incidence was 6.25% in Group A and 17.65% in Group B (P = 0.316), with a higher percentage of DVT-free patients in Group A (P = 0.041). From day 8 to 1 month postoperatively, no DVT cases were detected in Group A, while the incidence in Group B was 21.43% (P < 0.01). LMWH followed by Rivaroxaban significantly reduced DVT after PCL avulsion surgery. In addition, the D-D levels postoperatively were lower in the group of LMWH followed by Rivaroxaban group at 7 and 10 days after the operation. As for other inflammatory markers, there was no significant difference between the two groups. The reduction in DVT risk and D-Dimer levels suggests that the LMWH-rivaroxaban regimen may offer a clinically beneficial approach to anticoagulation therapy in patients undergoing PCL avulsion surgery.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

ALB :

Albumin

BMI:

Body mass index

CRP:

C-reactive protein

D-D:

D-dimer

DVT:

Deep vein thrombosis

ESR:

Erythrocyte sedimentation rate

Hb:

Hemoglobin

LMWH:

Low molecular weight heparin

MCVT:

Muscular calf vein thrombosis

NSAIDs:

Nonsteroidal anti-inflammatory drugs

ORIF:

Open reduction and internal fixation

PCL:

Posterior cruciate ligament

PE:

Pulmonary embolism

PPIs:

Proton pump inhibitors

PTVT:

Popliteal vein thrombosis

SD:

Standard deviation

VTE:

Venous thromboembolism

HIT:

Heparin-induced thrombocytopenia

UFH:

Unfractionated heparin

VKAs:

Vitamin K antagonists

INR:

International normalized ratio

DOACs:

Direct oral anticoagulants

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Acknowledgements

We would like to express our gratitude to Prof. Zhang Xiaoli, Prof. Liu Yajie, Prof. Qu Fanwei, Prof. Zhu Youbao, Miss Xie Haiping, Miss Wang Yue, Miss Pu Hui, Miss Cheng Yu, Miss Zhang Zilei and all the teachers from the International Education School at Kunming Medical University for their care and support.

Funding

1. Spring City Plan: The High-level Talent Promotion and Training Project of Kunming Yunnan Revitalization Talent Support Programme Young Talent Project (2024SCP001). 2. Applied Basic Research Foundation of Yunnan Province and Kunming Medical University (202201AY070001-194). 3. Kunming Health Commission Health Science and Technology Talent Project (2021-SW-14). 4. Applied Basic Research Foundation of Yunnan Province (202301AU070104). Applied Basic Research Foundation of Yunnan Province and Kunming Medical University (202301AY070001-180). 5. Kunming Health Commission Health Science and Technology Talent Project (2023-SW-65).

Author information

Authors and Affiliations

  1. Baoshan People’s Hospital, No. 2, Yongchang Road, Longyang District, Baoshan City, Yunnan Province, China

    Md Miftahul Mithu & Zhuoyuan Chen

  2. Department of Orthopedic Surgery, Yan’an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, China

    Md Miftahul Mithu, Jiazheng Huang, Huiqin Yang, Md Ariful Haque, Ying Xiong, Jiayu Xiao, Zhengzong Yang, Jie Wang, Zhongxiong Wu & Zhuoyuan Chen

  3. Institute of Neuroscience, Kunming Medical University, Kunming, 650500, Yunnan, China

    Md Miftahul Mithu & Ting-Hua Wang

  4. Department of Public Health, Kunming Medical University, Kunming, 650500, Yunnan, China

    Ronald Hartono

  5. Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province, Yan’an Hospital Affiliated to Kunming Medical University, Kunming, Yunnan, China

    Haiqing Li

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Contributions

Z.C., Z.W., and M.M.M. designed this study. M.M.M., Y.X., T.-H.W., and J.H. conducted this study. H.Y., H.L., and Z.Y., J.W. collected the data. R.H. and J.X. analyzed the data. M.M.M. and Z.C. and M.A.H. wrote the manuscript.All authors contributed to the final approval of the manuscript.

Corresponding authors

Correspondence to Zhongxiong Wu or Zhuoyuan Chen.

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Competing interests

The authors declare no competing interests.

Ethical approval

The ethical approval granted by the Yan’An Hospital Affiliated to Kunming Medical University Medical Ethics Committee (Ethical Approval Number: 2024-043-01), Kunming, Yunnan, China.

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Mithu, M.M., Wang, TH., Huang, J. et al. Deep vein thrombosis incidence after sequential Low-molecular-weight heparin and Rivaroxaban versus no prophylaxis in posterior cruciate ligament avulsion fractures. Sci Rep (2026). https://doi.org/10.1038/s41598-025-18884-0

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  • Received: 05 November 2024

  • Accepted: 04 September 2025

  • Published: 05 February 2026

  • DOI: https://doi.org/10.1038/s41598-025-18884-0

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Keywords

  • Posterior cruciate ligament (PCL)
  • Avulsion fracture
  • Low molecular weight heparin (LMWH)
  • Rivaroxaban
  • Deep vein thrombosis (DVT)
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