Comparative Study of Rivaroxaban With Enoxaparin as Thrombo Prophylaxis in Total Hip Replacement

Abstract

Background and Objectives: In total Hip arthroplasty, thromboembolism prophylaxis is a standard practice with minimal recommended duration of ten days. Thromboembolism prevention leads to reduction in symptomatic venous thromboembolic complications without risk of major bleeding.To assess and compare the efficacy of oral rivaroxaban with subcutaneous enoxaparin for prevention of thromboembolism after total hip and total knee replacement.
 Methods: It was a Randomized Control Trial conducted at Department of Orthopedic Surgery, Services Hospital Lahore.
 After permission from the Institutional review board, a total number of 200 patients who underwent either total hip replacement (THR) were enrolled in the study. These patients were divided into 2 equal groups A and B, each group having 100 patients. In Group A, all the patients were given Rivaroxaban 10 mg daily while in Group B Enoxaparin 40mg s/c was given. In all the patients’ anticoagulant prophylaxis was started 3-5 days before the surgery and 7-10 days after the surgery during Hospital stay.
 Results: In group A where all patients were given Tab Rivaroxaban 10mg daily, did not show any signs of DVT in the final follow up. In Group B DVT occurred in 2 patients (2%) during the 1st week post operatively. This shows that Rivaroxaban causes lower incidence of thromboembolism when compared to enoxaparin (relative risk of 0.70 & 95% of confidence interval).
 Conclusion: Rivaroxaban showed better anticoagulant effects than enoxaparin. It has slight higher risk of bleeding than enoxaparin. Direct factor Xa inhibitors are effective to prevent thromboembolism after total hip and total knee replacement. The anticoagulant effects are not necessarily compromised with risk of high bleeding.