Efficacy and safety of aspirin and rivaroxaban for venous thromboembolism prophylaxis after total hip or knee arthroplasty

Le, Guoping; Yang, Chengzhi; Zhang, Ming; Xi, Li-Cheng; Luo, Hanwen; Tang, Jun; Zhao, Jinmin

doi:10.1097/md.0000000000023055

Cited by 13 publications

(11 citation statements)

References 38 publications

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“…When comparing ASA and NOAC, the former had less risk of blood transfusion than rivaroxaban (RR = 0.94) 264 . A large trial (3,424 patients) did not find significant differences between ASA and rivaroxaban in clinically important bleeding (1.29% vs. 0.99%) or major bleeding (0.47% vs. 0.29%) 263 , and a recent meta-analysis 269 could not find any significant differences in any bleeding, major bleeding, minor bleeding, gastrointestinal tract bleeding or wound hematoma, between ASA or any other comparator.…”

Section: - Which Vte Prophylactic Agent Used In Patients Undergoing T...mentioning

confidence: 98%

“…Three major studies of safety comparisons were identified in the literature: LMWH versus ASA 248 , non-vitamin-K oral anticoagulants (NOAC, including direct factor Xa inhibitors and other, such as rivaroxaban, dabigatran, apixaban, ximelagatran, etc.) versus LMWH 249-262 or ASA 263-265 , and NOAC of different groups comparing to each other 252,266 . Bleeding rates are not always reported, and bleeding risks may be used as the surrogate.…”

Section: - Which Vte Prophylactic Agent Used In Patients Undergoing T...mentioning

confidence: 99%

“…Numerous studies have focused on comparing the use of ASA with direct oral anticoagulants. A recent meta-analysis included eight studies with 97,677 THA and TKA patients, three of which were RCT, comparing the use of rivaroxaban and ASA 349 . No difference was identified with regards to the rate of wound complications.…”

Section: - Does the Type Of Vte Prophylaxis Influence The Risk Of Sub...mentioning

confidence: 99%

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Recommendations from the ICM-VTE: Hip & Knee

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Hip & Knee Delegates* 1 -Is VTE after elective total joint arthroplasty a "never event"?Response/Recommendation: Venous thromboembolism (VTE) after elective total joint arthroplasty (TJA) continues to occur despite various strategies in prophylaxis and should not be considered a "never event."Strength of Recommendation: Moderate.Delegates vote: Agree 94.87% Disagree 5.13% Abstain 0.00% (Strong Consensus).Rationale: As part of an initiative to address quality of care and control healthcare costs, in 2002, the United States Centers for Medicare and Medicaid Services (CMS) defined "never events" as hospital-acquired conditions that were considered reasonably preventable 1 . In 2008, CMS added deep venous thrombosis (DVT) and pulmonary embolism (PE) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) 2 .Historically, DVT and PE were important risks for patients undergoing TJA. In a study of 7,959 patients between 1962 and 1973, Charnley et al., reported a non-fatal PE rate of 7.89% and a 1.04% rate of fatal PE which constituted the highest single cause of death after a THA 3 . Coventry et al., identified a cohort of 2012 THA from 1969 to 1971 of which 58 did not receive chemoprophylaxis past post-operative day five and observed a DVT rate of 3.4%, a non-fatal PE rate of 5.2%, and a fatal PE rate of 3.4% 4,5 . In a series performed between 1990 and 1991, Warwick et al., identified 1,162 patients undergoing THA without routine chemoprophylaxis, with DVT confirmed by venography in 1.89% of patients and a PE rate of 1.20% with a subsequent mortality rate of 0.34% 6 .Early studies demonstrated a much higher incidence of VTE for TKA 7,8 . However, DVT in TKA patients occur distally in the calf which are less likely to progress into a PE which was observed at a rate of 1.3% 9 with fatalities of 0.19 to 0.4% 9,10 . Stulburg et al., examined a series of 638 patients from 1974 to 1979 among which 49 patients inadvertently did not receive prophylaxis; an impressive 83% of these patients developed a DVT 11 .In a prospective study with 34,397 consecutive and unselected THA or TKA procedures, 32 (0.09%) had a VTE after median two days despite ongoing thromboprophylaxis 12 . All surgery was done in a fast-track setup with accelerated mobilization and discharge. Another study has shown a 90-day incidence of 0.41% of VTE after unicompartmental knee arthroplasty 13 . All patients received thromboprophylaxis until discharge and were operated in a fast-track setup with a median length of stay of one day.With VTE as a common and potentially dangerous complication after TKA and THA, safe and effective strategies for prophylaxis were developed and studied. When warfarin dosage is titrated to an international normalized ratio (INR) of 1.5 to 2.0 and administered for approximately six weeks, DVT occurred at a rate of 0.2 to 1% with a non-fatal PE rate of 0.1 to 0.3% [14][15][16] . Warfarin was found to consistently decreased rates of VTE when utilized after THA or TKA, but may lead to a significant risk ...

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Section: - Which Vte Prophylactic Agent Used In Patients Undergoing T...mentioning

confidence: 98%

Section: - Which Vte Prophylactic Agent Used In Patients Undergoing T...mentioning

confidence: 99%

Section: - Does the Type Of Vte Prophylaxis Influence The Risk Of Sub...mentioning

confidence: 99%

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Recommendations from the ICM-VTE: Hip & Knee

2022

Journal of Bone and Joint Surgery

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“…In previous research [21][22][23], the ratio of TKA to THA ranged from 1.3 to 1.5, the mean age ranged from 69.9 to 71.2 years, and the proportion of female sex ranged from 82.0 to 83.9 %. Le et al [24] completed a protocol for meta-analysis with 97,677 patients and showed that aspirin was as effective as rivaroxaban in preventing VTE after THA or TKA. However, in terms of DVT, aspirin showed an increased risk compared with rivaroxaban.…”

Section: Discussionmentioning

confidence: 99%

Current status survey of the extramural hospital management of venous thromboembolism after total hip and knee arthroplasty in China

Tong

Liu

Qin

et al. 2021

BMC Musculoskelet Disord

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Background Venous thromboembolism (VTE) is a potentially fatal complication after arthroplasty. Numerous prophylactic strategies and studies to reduce VTEs have focused on the duration of the hospital stay and on few extramural hospitals. This study aimed to investigate extramural hospital management of VTE after total hip/knee arthroplasty (THA/TKA) in China with a novel survey tool. Methods A total of 180 patients undergoing arthroplasty, including 68 THA patients and 112 TKA patients, were enrolled in this study. All patients received anticoagulant treatment management. A survey querying VTE management and adherence, such as therapy information, understanding of anticoagulation, satisfaction with the ability of medical staff, and satisfaction with health care costs, was administered by a questionnaire (TKA/THA Patients’ Experience with Anticoagulation in the Post-discharge Period) for quality improvement. Results The average age of the patients was 65.27 ± 13.62 years. All patients knew their follow-up times. 85 % of them were suggested that re-examine at the next 14 days, and the others at the next 28 days. All patients continued to visit the orthopaedic clinic after discharge without choosing other types of outpatient services, such as an anticoagulant clinic or home visit with a nurse/pharmacist or remote evaluation by telephone. A total of 96.6 % of all patients used new oral anticoagulants, and the most common treatment duration was 2–4 weeks (93.3 %). 48 % informed their physicians that they were taking anticoagulation medications when they visited ophthalmology, dentistry, dermatology, and other departments. The overall rate of satisfaction with anticoagulation management was 81.67 %, and 6.67 % of patients were not unsatisfied with their medical expenses. Patient compliance decreased with increasing follow-up time. Continuous follow-ups after discharge significantly improved patient compliance. Conclusions These results elucidate how we can improve the quality of anticoagulation. Continuous follow-up appointments for 30 days after discharge, especially for individuals over 65 years old, significantly improved patient satisfaction and reduced the incidence of VTE and medical costs.

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“…Nowadays, the direct-acting oral anticoagulants (DOACs, non-vitamin K-dependent oral anticoagulant) as direct thrombin inhibitor (dabigatran) and Factor Xa inhibitor (rivaroxaban, apixaban, edoxaban) would be the standard treatment for prevention of stroke and thromboembolism in nonvalvular atrial fibrillation patients or other primary diseases [ 1 2 ].…”

Section: Introductionmentioning

confidence: 99%

Hemoptysis in Quadriplegia with Atrial Fibrillation Who Was Taking Edoxaban: a Case Report

et al. 2021

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The direct-acting oral anticoagulants (DOACs) would be the standard treatment for the prevention of stroke and thromboembolism in nonvalvular atrial fibrillation patients. The adverse effects of greatest concern are bleeding especially major bleeding. We present a case of a patient with a history of nonvalvular atrial fibrillation and pacemaker, who developed severe anemia after massive hemoptysis while taking DOAC; however, he has continued taking DOAC. Through this case, we have summarized the current management of major bleeding associated with anticoagulation and discuss the optimal regimen for restarting of anticoagulation therapy.

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Efficacy and safety of aspirin and rivaroxaban for venous thromboembolism prophylaxis after total hip or knee arthroplasty

Cited by 13 publications

References 38 publications

Recommendations from the ICM-VTE: Hip & Knee

Recommendations from the ICM-VTE: Hip & Knee

Current status survey of the extramural hospital management of venous thromboembolism after total hip and knee arthroplasty in China

Hemoptysis in Quadriplegia with Atrial Fibrillation Who Was Taking Edoxaban: a Case Report

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