Comparison of the Efficacy and Safety of Aspirin and Rivaroxaban Following Enoxaparin Treatment for Prevention of Venous Thromboembolism after Hip Fracture Surgery

Abstract

Objective To compare the efficacy and safety of aspirin with rivaroxaban following treatment with enoxaparin for prevention of venous thromboembolism (VTE) after hip fracture surgery (HFS). Methods A total of 390 patients were enrolled in the trial. According to an odd or even number at the end of their registration number, the patients were divided into the aspirin group (n = 198) and the rivaroxaban group (n = 192). All patients were given enoxaparin subcutaneous injection after the operation and returned to the routine dose the next day until postoperative day five. The patients in the aspirin group received an additional 16 days of thromboprophylaxis with 100 mg of aspirin once daily. The rivaroxaban group was assigned to receive an additional 16 days of thromboprophylaxis with 10 mg of oral rivaroxaban once daily. Patients were followed for 90 days regarding VTE and bleeding complications. Results The incidence of VTE in the aspirin group and rivaroxaban group was 6.6% (13/198) and 5.7% (11/192), respectively (P = 0.83). The rate of major bleeding events occurred in two (1.0%) patients in the aspirin group and in one patient (0.5%) in the rivaroxaban group (P = 1.0). A combination of major bleeding and clinically relevant nonmajor bleeding occurred in five patients (2.5%) in the aspirin group and in six patients (3.1%) in the rivaroxaban group (P = 0.77). During the 90‐day follow‐up, a pulmonary embolism developed in one patient (0.5%) in the aspirin group and none in the rivaroxaban group (P = 1.0). Conclusions Extended prophylaxis for 21 days with aspirin was equivalent to the direct oral anticoagulant rivaroxaban after hip fracture surgery with an initial 5‐day postoperative course of enoxaparin. Aspirin may be an effective, safe, convenient, and cheap alternative for extended prophylaxis after hip fracture surgery.

Rivaroxaban versus aspirin in prevention of venous thromboembolism following total joint arthroplasty or hip fracture surgery: a meta-analysis

“…After reviewing the titles and abstracts, 1513 obviously unrelated literatures were excluded and 65 literatures were enrolled. Through full text reading, a total of 65 republished literatures and literatures with no research results were again excluded, and 7 studies [ 4 , 10 – 15 ] were finally included, with a total of 5133 patients. Among the 7 studies, there were 2605 patients in the rivaroxaban group and 2528 patients in the aspirin group.…”

“…A total of 7 literatures were included in this meta-analysis, among which 5 trials [ 4 , 10 – 12 , 15 ] were randomized controlled trials (RCTs) and 2 trials [ 13 , 14 ] were retrospective studies. In all the five RCT studies, reasonable randomization methods and hidden allocation methods were given, and in one of them, double-blind methods were used, with a low risk of bias.…”

“…Six studies including 4333 patients compared the incidence of perioperative VTE events between the rivaroxaban and aspirin groups [ 4 , 10 – 12 , 14 , 15 ]. The meta-analysis showed that there was no statistically significant difference in the incidence of postoperative VTE between the two groups (RR = 0.75, 95% CI 0.50–1.11, I 2 = 36%, p = 0.15), as shown in Fig.…”

“…Four studies with 4775 participants reported data for major bleeding [ 4 , 13 – 15 ]. In total, 12 out of 2425 patients in the rivaroxaban group experienced major bleeding, while 11 out of 2350 patients in the aspirin group experienced major bleeding.…”

Prognostic Implications of Preoperative Pneumonia for Geriatric Patients Undergoing Hip Fracture Surgery or Arthroplasty

“…Various comorbidities 7 (e.g. congestive heart failure, myocardial infarction, stroke, diabetes, chronic kidney disease, and preoperative pneumonia) and complications 8 (e.g. surgical or implant‐related complications, deep venous thrombosis, pulmonary embolism, delirium, postoperative pneumonia, urinary tract infection, acute myocardial infraction, acute heart failure, and acute kidney injury) have been reported to be related to increased 30‐day and 1‐year mortalities 9,10 following hip fractures.…”