Rivaroxaban 10 mg once-daily was more effective than enoxaparin in reducing symptomatic venous thromboembolism and all-cause mortality (0.5% vs 1.3%; OR 0.38; 95% CI 0.22-0.62; p<0.001).
Meta-Analysis (n=9,581)
Yes
Does rivaroxaban 10 mg oral once daily reduce the composite of symptomatic venous thromboembolism and all-cause mortality compared to enoxaparin 40 mg subcutaneously once daily in patients undergoing elective hip and knee replacement?
In patients undergoing elective hip and knee replacement, oral rivaroxaban 10 mg once daily is more effective than subcutaneous enoxaparin 40 mg once daily in preventing symptomatic venous thromboembolism and all-cause mortality without increasing major bleeding.
Effect estimate: OR 0.38 (95% CI 0.22 to 0.62)
Absolute Event Rate: 0.5% vs 1.3%
p-value: p=<0.001
A once-daily dose of rivaroxaban 10 mg, an oral, direct Factor Xa inhibitor, was compared with enoxaparin 40 mg subcutaneously once daily for prevention of venous thromboembolism in three studies of patients undergoing elective hip and knee replacement (RECORD programme). A pooled analysis of data from these studies (n = 9581) showed that rivaroxaban was more effective than enoxaparin in reducing the incidence of the composite of symptomatic venous thromboembolism and all-cause mortality at two weeks (0.4% vs 0.8%, respectively, odds ratio 0.44; 95% confidence interval 0.23 to 0.79; p = 0.005), and at the end of the planned medication period (0.5% vs 1.3%, respectively; odds ratio 0.38; 95% confidence interval 0.22 to 0.62; p < 0.001). The rate of major bleeding was similar at two weeks (0.2% for both) and at the end of the planned medication period (0.3% vs 0.2%). Rivaroxaban started six to eight hours after surgery was more effective than enoxaparin started the previous evening in preventing symptomatic venous thromboembolism and all-cause mortality, without increasing major bleeding.
Eriksson et al. (Thu,) conducted a meta-analysis in elective hip and knee replacement (n=9,581). rivaroxaban vs. enoxaparin 40 mg subcutaneously once daily was evaluated on composite of symptomatic venous thromboembolism and all-cause mortality at the end of the planned medication period (OR 0.38, 95% CI 0.22 to 0.62, p=<0.001). Rivaroxaban 10 mg once-daily was more effective than enoxaparin in reducing symptomatic venous thromboembolism and all-cause mortality (0.5% vs 1.3%; OR 0.38; 95% CI 0.22-0.62; p<0.001).