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Objective To evaluates the efficacy and safety of rivaroxaban versus aspirin in prevention of venous thromboembolism (VTE) following total hip (THA) or knee arthroplasty (TKA) or hip fracture surgery. Methods Major databases were systematically searched for all relevant studies published in English up to October 2020. The meta-analysis was conducted using RevMan 5.3 software. Results In total, 7 studies were retrieved which contained 5133 patients. Among these patients, 2605 patients (50.8%) received rivaroxaban, whereas 2528 patients (49.2%) received aspirin. There were no statistical difference between aspirin and rivaroxaban for reducing VTE (RR = 0.75, 95% CI 0.50–1.11, I2 = 36%, p = 0.15), major bleeding (RR = 0.94, 95% CI 0.45–2.37, I2 = 21%, p = 0.95), and all-cause mortality (RR = 0.88, 95% CI 0.12–6.44, I2 = 0%, p = 0.90) between the two groups. Compared with aspirin, rivaroxaban significantly increased nonmajor bleeding (RR = 1.29, 95% CI 1.05–1.58, I2 = 0%, p = 0.02). Conclusion There was no significant difference between aspirin and rivaroxaban in prevention of venous thromboembolism following total joint arthroplasty or hip fracture surgery. Aspirin may be an effective, safe, convenient, and cheap alternative for prevention of VTE. Further large randomized studies are required to confirm these findings.

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BackgroundPrevious studies have demonstrated that the common laryngoscopic approach (right-sided) and midline approach are both used for endotracheal intubation by direct laryngoscopy. Although the midline approach is commonly recommended for video laryngoscopy (VL) in the clinic, there is a lack of published evidences to support this practice. This study aimed to evaluate the effects of different video laryngoscopic approaches on intubation.MethodsTwo hundred sixty-two patients aged 18 years who underwent elective surgery under general anaesthesia and required endotracheal intubation were included in the present prospective, randomized, controlled study. The participants were randomly and equally allocated to the right approach (Group R) or midline approach (Group M). All the intubations were conducted by experienced anaesthetists using GlideScope video laryngoscopy. The primary outcomes were Cormack-Lehane laryngoscopic views (CLVs) and first-pass success (FPS) rates. The secondary outcomes were the time to glottis exposure, time to tracheal intubation, haemodynamic responses and other adverse events. Comparative analysis was performed between the groups.ResultsFinally, 262 patients completed the study, and all the tracheas were successfully intubated. No significant differences were observed in the patient characteristics and airway assessments (P > 0.05). Compared with Group R, Group M had a better CLV (χ2 = 14.706, P = 0.001) and shorter times to glottis exposure (8.82 ± 2.04 vs 12.38 ± 1.81; t = 14.94; P < 0.001) and tracheal intubation (37.19 ± 5.01 vs 45.23 ± 4.81; t = 13.25; P < 0.001), but no difference was found in the FPS rate (70.2% vs 71.8%; χ2 = 0.074; P = 0.446) and intubation procedure time (29.86 ± 2.56 vs 30.46 ± 2.97, t = 1.75, P = 0.081). Between the groups, the rates of hoarseness or sore throat, minor injury, hypoxemia and changes in SBP and HR showed no significant difference (P > 0.05).ConclusionAlthough the FPS rate did not differ based on the laryngoscopic approach, the midline approach could provide better glottis exposure and shorter times to glottis exposure and intubation. The midline approach should be recommended for teaching in VL-assisted endotracheal intubation.Trial registrationThe study was registered on May 18, 2019 in the Chinese Clinical Trial Registry (ChiCTR1900023252).

Background: Previous studies have demonstrated that the common laryngoscopic approach (right-sided) and midline approach are both used for endotracheal intubation by direct laryngoscopy. Although the midline approach is commonly recommended for video laryngoscopy (VL) in the clinic, there is a lack of published evidences to support this practice. This study aimed to evaluate the effects of different video laryngoscopic approaches on intubation. Methods: Two hundred sixty-two patients aged 18 years who underwent elective surgery under general anaesthesia and required endotracheal intubation were included in the present prospective, randomized, controlled study. The participants were randomly and equally allocated to the right approach (Group R) or midline approach (Group M). All the intubations were conducted by experienced anaesthetists using GlideScope video laryngoscopy. The primary outcomes were Cormack-Lehane laryngoscopic views (CLVs) and first-pass success (FPS) rates. The secondary outcomes were the time to glottis exposure, time to tracheal intubation, haemodynamic responses and other adverse events. Comparative analysis was performed between the groups. Results: Finally, 262 patients completed the study, and all the tracheas were successfully intubated. No significant differences were observed in the patient characteristics and airway assessments ( P >0.05). Compared with Group R, Group M had a better CLV ( χ2 =14.706, P =0.001) and shorter times to glottis exposure (8.82±2.04 vs 12.38±1.81; t =14.94; P <0.001) and tracheal intubation (37.19±5.01 vs 45.23±4.81; t =13.25; P <0.001), but no difference was found in the FPS rate (70.2% vs 71.8%; χ2 =0.074; P =0.446) and intubation procedure time (29.86±2.56 vs 30.46±2.97, t =1.75, P =0.081). Between the groups, the rates of hoarseness or sore throat, minor injury, hypoxemia and changes in SBP and HR showed no significant difference ( P >0.05). Conclusion: Although the FPS rate did not differ based on the laryngoscopic approach, the midline approach could provide better glottis exposure and shorter times to glottis exposure and intubation. The midline approach should be recommended for teaching in VL-assisted endotracheal intubation. Trial registration: The study was registered in the Chinese Clinical Trial Registry ( ChiCTR-RNC-1900023252 ).

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Background: Previous studies demonstrated that the common laryngoscopic approach (right-sided) and midline approach are both used for endotracheal intubation by direct laryngoscopy. Although a midline approach is commonly recommended for video laryngoscopy (VL) in clinical, lacking of published evidences to support it. The study aimed to evaluate the effects of different video laryngoscopic approach on intubation. Methods: Two hundred and sixty-two patients aged 18 years who underwent elective surgery in general anesthesia, requiring endotracheal intubation, were included in the prospective, randomized, controlled study. Participants were randomly and equally allocated to right approach (Group R) or midline approach (Group M). All intubations were conducted with GlideScope video laryngoscopy by experienced anaesthetists. The primary outcomes were Cormack-Lehane laryngoscopic views (CLV) and first-pass success (FPS) rate. The secondary outcomes were time to glottis exposure, time to tracheal intubation, hemodynamic response and other adverse events. Comparative analysis was performed between the both groups. Results: All patients ultimately were successfully intubated. No significant differences were observed in patient characteristics and airway assessments (P＞0.05). Compared with Group R, Group M had a better CLV (χ2=14.706, P=0.001) and shorter time to glottis exposure (8.82±2.04 vs 12.38±1.81, t=14.94, P<0.001) and tracheal intubation (37.19±5.01 vs 45.23±4.81, t=13.25, P<0.001), but no difference in FPS rate (70.2% vs 71.8%, χ2=0.074, P=0.446). Between groups, the rates of hoarseness or sore throat, minor injury, hypoxemiaand changes of SBP and HR were noted no significant difference (P＞0.05). Conclusion: Although FPS rate did not differ based upon laryngoscopic approach type; however, the midline approach could provide a better glottis exposure, shorter time to glottis exposure and intubation. The midline approach should be recommended for teaching in VL-assisted endotracheal intubation. Trial registration: The study was registered in Chinese Clinical Trial Registry (ChiCTR-RNC-13003898). Keywords: endotracheal intubation; video laryngoscopic; laryngoscopic approach