Rivaroxaban Versus Enoxaparin for Venous Thromboembolism Prophylaxis after Hip and Knee Arthroplasty

Charters, Michael A.; Frisch, Nicholas B.; Wessell, Nolan M.; Dobson, Christopher E.; Les, Clifford M.; Silverton, Craig D.

doi:10.1016/j.arth.2015.02.009

Cited by 26 publications

(13 citation statements)

References 17 publications

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“…Deep vein thrombosis (DVT) is a frequent and significant complication after total knee arthroplasty (TKA) [ 1 , 2 ]. However, the incidence, diagnosis, prevention, and treatment of DVT remain controversial [ 1 , 3 – 9 ]. Differences in the DVT incidence between Asian and Western populations may have aggravated the controversies [ 10 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

Incidence of deep vein thrombosis before and after total knee arthroplasty without pharmacologic prophylaxis: a 128-row multidetector CT indirect venography study

Chang

Song

Kyung

et al. 2018

BMC Musculoskelet Disord

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BackgroundWe sought to document the incidences of deep vein thrombosis (DVT) before and after total knee arthroplasty (TKA). In addition, we aimed to explor whether routine preoperative DVT evaluation was useful to establish DVT treatment strategies after TKA. Finally, we wanted to evaluate whether the incidences of DVT differed between patients undergoing unilateral and staged bilateral TKA within the same hospitalization period.MethodsThe retrospective study included 153 consecutive patients (253 knees) with osteoarthritis who underwent primary TKA. After surgery, mechanical compression devices (only) were used for DVT prophylaxis. DVT status before and after TKA was determined via 128-row, multidetector, computed tomography/indirect venography.ResultsOverall, the preoperative DVT incidence was 2.6% per patient and 1.6% per knee. All preoperative DVTs were distal in nature and asymptomatic. After TKA, newly developed thrombi were evident in various calf veins, without propagation of any pre-existing thrombi. Postoperatively, the overall incidences of DVT were 69.9% per patient and 58.5% per knee. The DVT incidences were 66% per patient and 69.8% per knee in the unilateral TKA group. In contrast, the incidences were 72% per patient and 55.5% per knee in the staged bilateral TKA group. There was one case of symptomatic distal (unilateral TKA; 0.65% per patient and 0.4% per knee) and proximal DVT (bilateral TKA; 0.65% per patient and 0.4% per knee), respectively.ConclusionsThe incidence of symptomatic DVT was low in Asian patients treated with mechanical compression devices alone, although substantial portion of patients had DVT after surgery. Routine preoperative DVT evaluation is probably not necessary; preoperative DVT was rare and of limited clinical relevance. Furthermore, staged bilateral TKA during a single period of hospitalization does not increase the incidence of DVT.

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Section: Introductionmentioning

confidence: 99%

Incidence of deep vein thrombosis before and after total knee arthroplasty without pharmacologic prophylaxis: a 128-row multidetector CT indirect venography study

Chang

Song

Kyung

et al. 2018

BMC Musculoskelet Disord

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“…[6–9] Some studies also found no demonstrable differences between rivaroxaban and enoxaparin in rates of VTE, transfusion, reoperation, infection, or major bleeding after hip and knee arthroplasty. [10,11] Chahal et al [12] suggested that there is no consensus on the optimal form of VTE prophylactic treatment in knee arthroplasty patients or on the complication and safety profile of the available chemical prophylactic modalities.…”

Section: Introductionmentioning

confidence: 99%

Rivaroxaban versus enoxaparin for the prevention of venous thromboembolism after total knee arthroplasty

Huang

Yang

et al. 2018

Medicine

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Objective:This article analyzed the clinical efficacy and tolerability of rivaroxaban and enoxaparin in patients undergoing total knee arthroplasty (TKA) surgery.Methods:Five randomized, controlled clinical trials on rivaroxaban versus enoxaparin in patients who underwent TKA were identified and included in this meta-analysis.Results:The meta-analysis indicated that rivaroxaban prophylaxis was associated with lower rates of symptomatic venous thromboembolism (VTE) (relative risk[RR]:0.55; 95% confidence interval [CI]: 0.35–0.86; P = .009), symptomatic deep vein thrombosis (DVT) (RR 0.44, 95% CI 0.25–0.80, P = .007), asymptomatic DVT (RR: 0.57; 95% CI: 0.37–0.89; P = .01), distal DVT (RR: 0.62; 95% CI: 0.45–0.85; P = .003) and proximal DVT (RR: 0.42; 95% CI: 0.24–0.75; P = .004). Compared with the enoxaparin group, the incidence of symptomatic pulmonary embolism (PE) (RR: 0.48; 95% CI: 0.19–1.24; P = .13) in the rivaroxaban group was not significantly different. A nonsignificant trend towards all-cause death (RR: 0.38; 95% CI: 0.03–4.92; P = .46) or major bleeding (RR: 1.59; 95% CI: 0.77–3.27; P = .21) risk between rivaroxaban and enoxaparin prophylaxis was found.Conclusion:Compared with the enoxaparin group, the group using rivaroxaban after TKA had a significantly lower rate of symptomatic VTE, symptomatic DVT, asymptomatic DVT, distal DVT, and proximal DVT. Our study shows that rivaroxaban after TKA is more effective than enoxaparin and did not increase major bleeding or all-cause mortality.Level of evidence II

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“…33 Charters et al reported no difference when comparing transition to the NOACs to historical data with regard to the rates of VTE, infection, reoperations, transfusions, or major bleeding. 34 Wang et al found an increased rate of bleeding complications when rivaroxaban was used without tranexamic acid. 35 When compared with aspirin, the NOACs (both factor Xa and direct thrombin inhibitors) were associated with increased rates of bleeding and wound complications.…”

Section: Newer Oral Anticoagulants (Noac): Direct Factor Xa and Direcmentioning

confidence: 99%

Venous Thromboembolism Prophylaxis after Total Knee Arthroplasty

2018

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Venous thromboembolic disease (VTED) is a major cause of morbidity and mortality after total knee arthroplasty (TKA). Current VTED prophylaxis protocols consist of early mobilization, mechanical compression devices, and pharmacologic agents. Venous phasic flow-regulated below-knee devices are generally favored, but the optimal duration and method of mechanical prophylaxis is unknown. Risk stratification models have been developed to guide pharmacologic prophylaxis. For patients with standard VTED risk profile, aspirin has become increasingly popular. Recent studies have validated the efficacy, relatively low bleeding risks, and cost-effectiveness of aspirin in the patients with standard risk profile. Current evidence suggests that the newer oral anticoagulants, including the factor Xa and the direct thrombin inhibitors, are effective for the reduction of postoperative VTED but may be associated with increased bleeding and wound complication rates.

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Rivaroxaban Versus Enoxaparin for Venous Thromboembolism Prophylaxis after Hip and Knee Arthroplasty

Cited by 26 publications

References 17 publications

Incidence of deep vein thrombosis before and after total knee arthroplasty without pharmacologic prophylaxis: a 128-row multidetector CT indirect venography study

Incidence of deep vein thrombosis before and after total knee arthroplasty without pharmacologic prophylaxis: a 128-row multidetector CT indirect venography study

Rivaroxaban versus enoxaparin for the prevention of venous thromboembolism after total knee arthroplasty

Venous Thromboembolism Prophylaxis after Total Knee Arthroplasty

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