Comparison of Postoperative Bleeding in Total Hip and Knee Arthroplasty Patients Receiving Rivaroxaban or Enoxaparin

Ricket, Abby L.; Stewart, David W.; Wood, Robert C.; Cornett, Lyndsey; Odle, Brian; Cluck, David; Freshour, Jessica; El-Bazouni, Hadi

doi:10.1177/1060028015626435

Cited by 21 publications

(25 citation statements)

References 24 publications

(24 reference statements)

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Section: Discussioncontrasting

confidence: 60%

“…Other authors have reported clinical bleeding event rates with rivaroxaban cohorts as high as 6.8%, much higher than the 3.2% reported in the RECORD trials and as seen in our population. 12,13 One reason for lower rivaroxabanrelated bleeding events in our institution may be related to delayed administration as a result of surgeon preference to start rivaroxaban the morning after surgery. This would typically result in greater than the 6-to 8-hour postwound closure initiation studied by RECORD and 6-to 10-hour post-wound closure initiation in the prescribing information.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Retrospective Evaluation of Postoperative Adverse Drug Events in Patients Receiving Rivaroxaban After Major Orthopedic Surgery Compared with Standard Therapy in a Community Hospital

et al. 2017

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Section: Discussioncontrasting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Retrospective Evaluation of Postoperative Adverse Drug Events in Patients Receiving Rivaroxaban After Major Orthopedic Surgery Compared with Standard Therapy in a Community Hospital

et al. 2017

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“…30 A retrospective review by Ricket et al determined that rivaroxaban prophylaxis following total joint arthroplasty led to increased incidence of major bleeding and clinically relevant nonmajor bleeding versus enoxaparin (6.3 vs. 2.2%, p < 0.01). 31 Finally, the XAMOS study, which reviewed real-world use of rivaroxaban following major orthopaedic surgery, found that treatment cessation for bleeding was higher with rivaroxaban than for LMWH (0.4 vs. 0.2%) and that treatment-emergent nonmajor bleeding occurred more often in the rivaroxaban group versus the LMWH group (4.18 vs. 2.79%, OR: 1.52; 95% CI, 1.29-1.79). 32 In the RECORD clinical trials, the study groups were evenly stratified based on demographic and surgical characteristics.…”

Section: Discussionmentioning

confidence: 99%

The Effect of BMI and Gender on Bleeding Events when Rivaroxaban Is Administered for Thromboprophylaxis Following Total Hip and Total Knee Arthroplasty

Krauss

Cronin

Dengler

et al. 2018

Semin Thromb Hemost

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Rivaroxaban is approved in Europe and the United States for thromboprophylaxis following total joint arthroplasty. As the rate of obesity increases, confirming safety and efficacy in this patient population is paramount. This retrospective chart review assessed the efficacy and safety of rivaroxaban between two body mass index (BMI) groups: normal or overweight (< 30 kg/m2) and obese or morbidly obese (≥30 kg/m2). Safety outcome was a major bleeding event, defined as a decrease in hemoglobin of at least 2 g/dL from postoperative day 1(POD 1) to discharge or a blood transfusion of at least two units. Efficacy outcome was venous thromboembolism within 35 days postoperatively. There were 68 (68/1,241; 5.48%) major bleeding events. There was no significant association between major bleeding events and BMI in the univariable analysis (p < 0.36). However, after adjusting for other factors in the multivariable model, there was a significant interaction between BMI and gender (p < 0.001). Among males, the incidence of major bleeding events was three times greater in obese/morbidly obese subjects as compared with normal/overweight male subjects (odds ratio [OR]: 3.09, 95% confidence interval [CI]: 1.25, 7.62). Among females, incidence of having a major bleeding event was almost two times greater in normal/overweight subjects as compared with obese/morbidly obese female subjects (OR: 2.17, 95% CI: 1.10, 4.35). Incidence of venous thromboembolism was 0.4% in each group. The authors' study results highlight a previously unexplored association between BMI and gender-dependent differences in bleeding outcomes when rivaroxaban is used for thromboprophylaxis following total joint arthroplasty.

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“… 23 Ricket et al. 24 compared the treatment effect of rivaroxaban and nadroparin in elderly patients undergoing THA and found that the incidence of DVT was 3.75% (6/160) in the rivaroxaban group and 10.63% (17/160) in the nadroparin group. The difference was statistically significant (P<0.02).…”

Section: Discussionmentioning

confidence: 99%

Rivaroxaban versus nadroparin for preventing deep venous thrombosis after total hip arthroplasty following femoral neck fractures: A retrospective comparative study

Zhang

Liang

et al. 2018

J Int Med Res

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ObjectiveThis study was performed to evaluate the efficacy of rivaroxaban versus nadroparin for preventing deep venous thrombosis (DVT) in elderly patients with osteoporosis undergoing initial total hip arthroplasty (THA) for femoral neck fractures.MethodsProspectively maintained databases were reviewed to retrospectively compare elderly patients with osteoporosis who underwent initial THA for femoral neck fractures from 2007 to 2015. The patients received peroral rivaroxaban at 10 mg/day for 2 weeks or subcutaneous injections of nadroparin at 0.3 mL/day for 2 weeks until the primary analysis cut-off date. The time to first on-study DVT was the primary endpoint.ResultsIn total, 399 patients were included (rivaroxaban group: n=200; mean age, 70.20 ± 9.16 years and nadroparin group: n = 199; mean age, 69.90 ± 8.87 years), with a mean 3-year follow-up. The time to first on-study DVT was significantly longer in the rivaroxaban than nadroparin group (12 and 5 days, respectively). The incidence of DVT within the 2-week follow-up was significantly higher in the nadroparin than rivaroxaban group (6.8% and 19.7%, respectively), but this difference was no longer present at the final follow-up.ConclusionRivaroxaban was associated with a significant reduction in the occurrence of first on-study DVT compared with nadroparin.

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Comparison of Postoperative Bleeding in Total Hip and Knee Arthroplasty Patients Receiving Rivaroxaban or Enoxaparin

Abstract: The use of enoxaparin for VTE prophylaxis following THA and TKA was associated with a lower rate of the primary outcome (any postoperative bleeding) compared with the use of rivaroxaban in a similar cohort of patients.

Cited by 21 publications

References 24 publications

Retrospective Evaluation of Postoperative Adverse Drug Events in Patients Receiving Rivaroxaban After Major Orthopedic Surgery Compared with Standard Therapy in a Community Hospital

Retrospective Evaluation of Postoperative Adverse Drug Events in Patients Receiving Rivaroxaban After Major Orthopedic Surgery Compared with Standard Therapy in a Community Hospital

The Effect of BMI and Gender on Bleeding Events when Rivaroxaban Is Administered for Thromboprophylaxis Following Total Hip and Total Knee Arthroplasty

Rivaroxaban versus nadroparin for preventing deep venous thrombosis after total hip arthroplasty following femoral neck fractures: A retrospective comparative study

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