Key result
Rivaroxaban cuts post-TKA deep venous thrombosis ~40% vs. LMWH, but increases major bleeding risk.
Why the study?
Does rivaroxaban reduce thrombotic outcomes compared to low molecular weight heparin for thrombo-prophylaxis in patients following total knee arthroplasty?
Meta-Analysis (n=26,675)
Does rivaroxaban reduce thrombotic outcomes compared to low molecular weight heparin for thrombo-prophylaxis in patients following total knee arthroplasty?
Relative Risk: 0.6 (95% CI 0.51–0.71)
p-value: p=0.00001
Rivaroxaban provides superior efficacy in preventing venous thromboembolism after total knee arthroplasty compared to enoxaparin, but at the cost of a significantly increased risk of bleeding.
Alerts clinicians to elevated bleeding risk with rivaroxaban after TKA; leaves net benefit open for prospective validation.
INTRODUCTION: In this analysis, we aimed to systematically compare the clinical outcomes observed with rivaroxaban versus low molecular weight heparin (LMWH) [enoxaparin] for thrombo-prophylaxis following total knee arthroplasty (TKA). METHODS: Relevant studies based on rivaroxaban versus LMWH for thrombo-prophylaxis following TKA were searched through online databases. Data sources were MEDLINE, EMBASE, Cochrane database, Google scholar, www. CLINICALTRIALS: gov and Web of Science. Nine studies with a total number of 26,675 participants were included. Clinical outcomes (adverse efficacy and bleeding outcomes) were considered as the endpoints in this analysis. The Revman software was used for data analysis. Risk ratios (RR) with 95% confidence intervals (CI) were used to represent the results. RESULTS: A total number of 26,675 participants were included in this analysis whereby 13,496 participants were assigned to rivaroxaban and 13,179 participants were assigned to LMWH. Our current results showed that deep venous thrombosis (RR: 0.60, 95% CI: 0.51 - 0.71; P = 0.00001), venous thromboembolism (RR: 0.56, 95% CI: 0.45 - 0.70; P = 0.00001), and all-cause mortality (RR: 0.54, 95% CI: 0.33 - 0.87; P = 0.01) were significantly lower with rivaroxaban compared to LMWH for thrombo-prophylaxis after TKA. Adverse cardiac events (RR: 1.50, 95% CI: 0.53 - 4.21; P = 0.44) were similarly manifested. However, any bleeding event (RR: 1.18, 95% CI: 1.07 - 1.31; P = 0.001), major bleeding (RR: 1.54, 95% CI: 1.12 - 2.11; P = 0.008), non-major bleeding (RR: 1.15, 95% CI: 1.01 - 1.30; P = 0.03), minor bleeding (RR: 1.19, 95% CI: 1.06 - 1.32; P = 0.002) and bleeding leading to re-operation (RR: 1.62, 95% CI: 1.08 - 2.44; P = 0.02) were significantly higher with rivaroxaban when compared to LMWH. CONCLUSION: Our analysis showed that rivaroxaban when used as thrombo-prophylaxis following TKA, significantly reduced thrombotic outcomes when compared to LMWH. However, the risks of bleeding events including major and minor bleeding events were significantly increased in comparison to LMWH. Therefore, further larger studies should be able to confirm our hypothesis.
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Dai et al. (2026) conducted a meta-analysis in Thrombo-prophylaxis following total knee arthroplasty (n=26,675). Rivaroxaban vs. Low molecular weight heparin (Enoxaparin) was evaluated on Deep venous thrombosis (RR 0.60, 95% CI 0.51 - 0.71, p=0.00001). Rivaroxaban significantly reduced deep venous thrombosis (RR 0.60) compared to LMWH following total knee arthroplasty, but increased the risk of major bleeding (RR 1.54).
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