Rivaroxaban versus enoxaparin for the prevention of venous thromboembolism after total knee arthroplasty

Abstract

Objective:This article analyzed the clinical efficacy and tolerability of rivaroxaban and enoxaparin in patients undergoing total knee arthroplasty (TKA) surgery.Methods:Five randomized, controlled clinical trials on rivaroxaban versus enoxaparin in patients who underwent TKA were identified and included in this meta-analysis.Results:The meta-analysis indicated that rivaroxaban prophylaxis was associated with lower rates of symptomatic venous thromboembolism (VTE) (relative risk[RR]:0.55; 95% confidence interval [CI]: 0.35–0.86; P = .009), symptomatic deep vein thrombosis (DVT) (RR 0.44, 95% CI 0.25–0.80, P = .007), asymptomatic DVT (RR: 0.57; 95% CI: 0.37–0.89; P = .01), distal DVT (RR: 0.62; 95% CI: 0.45–0.85; P = .003) and proximal DVT (RR: 0.42; 95% CI: 0.24–0.75; P = .004). Compared with the enoxaparin group, the incidence of symptomatic pulmonary embolism (PE) (RR: 0.48; 95% CI: 0.19–1.24; P = .13) in the rivaroxaban group was not significantly different. A nonsignificant trend towards all-cause death (RR: 0.38; 95% CI: 0.03–4.92; P = .46) or major bleeding (RR: 1.59; 95% CI: 0.77–3.27; P = .21) risk between rivaroxaban and enoxaparin prophylaxis was found.Conclusion:Compared with the enoxaparin group, the group using rivaroxaban after TKA had a significantly lower rate of symptomatic VTE, symptomatic DVT, asymptomatic DVT, distal DVT, and proximal DVT. Our study shows that rivaroxaban after TKA is more effective than enoxaparin and did not increase major bleeding or all-cause mortality.Level of evidence II

Comparison of the Efficacy and Safety of Rivaroxaban and Enoxaparin as Thromboprophylaxis Agents for Orthopedic Surgery—Systematic Review and Meta-Analysis

“…Rivaroxaban, which is included in the novel anticoagulant (NOAC) group, works through the direct inhibition of factor Xa, which is involved in coagulation [ 22 ]. Factor Xa is involved in the common pathway, and its inhibition leads to the prevention of clot formation and thrombin generation [ 22 , 23 ]. It reversibly and competitively binds to circulating and clot-bound factor Xa through S1 and S4 pockets, resulting in high selectivity to factor Xa compared to other factors [ 22 , 23 ].…”

“…Factor Xa is involved in the common pathway, and its inhibition leads to the prevention of clot formation and thrombin generation [ 22 , 23 ]. It reversibly and competitively binds to circulating and clot-bound factor Xa through S1 and S4 pockets, resulting in high selectivity to factor Xa compared to other factors [ 22 , 23 ]. The direct and selective action of rivaroxaban is shown to increase effectivity compared to other indirect factor Xa inhibitors such as VKA or LMWH [ 5 , 22 , 23 ].…”

Prophylaxis with rivaroxaban after laparoscopic sleeve gastrectomy could reduce the frequency of portomesenteric venous thrombosis

“…They have proven effective in preventing venous thromboembolism after orthopaedic surgery, for stroke prevention in patients with atrial fibrillation, and have been approved for the treatment of deep vein thrombosis and pulmonary embolism. [9][10][11][12][13][14][15][16][17] There are also studies comparing the use of direct oral anticoagulants with LMWH for the prevention of venous thromboembolism in orthopaedic surgery where it is more effective in the prevention of venous thromboembolism after arthroscopy compared with enoxaparin, without increasing the risk of major bleeding. [11][12][13] Data from meta-analyses and randomised trials of patients with venous thromboembolism report similar efficacy and reduced rates of bleeding when direct oral anticoagulants are compared with vitamin K antagonist.…”

“…[9][10][11][12][13][14][15][16][17] There are also studies comparing the use of direct oral anticoagulants with LMWH for the prevention of venous thromboembolism in orthopaedic surgery where it is more effective in the prevention of venous thromboembolism after arthroscopy compared with enoxaparin, without increasing the risk of major bleeding. [11][12][13] Data from meta-analyses and randomised trials of patients with venous thromboembolism report similar efficacy and reduced rates of bleeding when direct oral anticoagulants are compared with vitamin K antagonist. [18][19][20][21][22][23][24][25] A recent meta-analysis suggested that single thromboprophylaxis with rivaroxaban is more effective in the prevention of deep vein thrombosis in elective total knee replacement than combination strategies.…”

“…[9][10][11][12][13][14][15][16][17] There are studies comparing the use of direct oral anticoagulants with low molecular weight heparin (LMWH) for the prevention of venous thromboembolism in orthopaedic surgery, in which its use is more effective for prevention of venous thromboembolism without increasing major bleeding risk. [11][12][13] Data from meta-analyses and randomised trials of patients with venous thromboembolism report similar efficacy and reduced rates of bleeding when direct oral anticoagulants are compared with vitamin K antagonist. [18][19][20][21][22][23][24][25] Several studies have described the pharmacological safety and anticoagulation efficacy of rivaroxaban in sleeve gastrectomy but, to our knowledge, there are no studies reporting the clinical safety and results of the use of rivaroxaban for PMVT prophylaxis after laparoscopic sleeve gastrectomy.…”