Rivaroxaban vs Enoxaparin for Thromboprophylaxis after Hip Arthroplasty

The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery

“…These have been thoroughly investigated in clinical trials using TKR, THR and hip fracture models, with figures of 2.9 -6.5% for nonmajor bleeding, 0.6 -1.0% for wound-related infections, <0.1 -4.9% for major bleeding, 0 -0.4% for cerebrovascular adverse events, and 0 -1.4% for death from any cause. [7][8][9][10] The decision whether or not to use thrombosis chemoprophylaxis is therefore decided by weighing up the patient's risk for bleeding against the risk of developing VTE. No universal guidelines are available, although the general consensus from various bodies [31,34,38,40] and published articles [6,12,13,21,22,24,25,27,30,33,39] is that use of prophylactic anticoagulation is not advocated in foot and ankle surgery In a previous prospective study, [37] we found that the absolute number of cases of VTE after foot and ankle surgery was unacceptably high (11/130 (8.5%)), although this was not statistically significant owing to the relatively small number of cases.…”

“…[6] The prevalence of VTE and the use of pharmacological thromboprophylaxis in total hip replacement (THR), total knee replacement (TKR) and hip fractures have been well documented in published literature and in clinical trials. [1,[7][8][9][10] Although there is potentially an increased risk of VTE in foot and ankle surgery, the incidence of VTE is poorly understood. None of the available studies are comparable owing to non-uniformity of the patient populations, failure to distinguish between symptomatic and silent thrombosis, the considerable diversity in foot and ankle pathology, and varying aftercare protocols, which may be why the reported incidence of VTE after foot and ankle surgery ranges widely, from 0% to 36%.…”

“…[6,[8][9][10][11][12][13][14][15][16][17][18][19][20]26,37,41] A difficulty of long-term follow-up of patients is that many DVT events occur several weeks or longer after discharge. [37,42] …”

Thrombembolic complications after total ankle replacement

“…In the last 36 months an alternative oral application of rivaroxaban (Xarelto, 10 mg, Bayer AG, Zürich) has been used. Rivaroxaban has been shown to be superior to enoxaparin for thromboprophylaxis after total knee [66] and total hip replacement [67] with similar rates of bleeding. However, to date there is no literature addressing the efficacy and safety of rivaroxaban in patients who underwent foot and ankle surgery.…”

Venous Thromboembolism: A Need for More Public Awareness and Research Into Mechanisms

“…Recent data from the RECORD 1 clinical study showed that the orally-available Factor Xa inhibitor rivaroxaban reduced venous thromboembolic events from 3.7% to 1.1% compared with the low molecular weight heparin enoxaparin in patients undergoing total hip replacement. 6 In the future, these new drugs may be used in place of both heparins and vitamin K antagonists and, if so, can be expected to have a huge impact on the treatment of VTE. The final scientific article is by Dr Wakefield and colleagues and discusses the mechanisms of venous thrombosis and resolution.…”