Why the study?
Patients undergoing total knee arthroplasty are at high risk for venous thromboembolism, and the efficacy of oral rivaroxaban as thromboprophylaxis required evaluation.
Does oral rivaroxaban 10 mg once daily prevent venous thromboembolism in patients undergoing elective primary total knee arthroplasty?
Does oral rivaroxaban 10 mg once daily prevent venous thromboembolism in patients undergoing elective primary total knee arthroplasty?
Oral rivaroxaban 10 mg once daily for 14 days is an effective and safe modality for preventing venous thromboembolism after total knee arthroplasty.
Single-arm cohort shows low VTE rates with rivaroxaban post-TKA; leaves open need for randomized comparisons before changing practice.
Background: Venous thromboembolism (VTE) is a major healthcare problem that affects more than 1.6 million persons each year worldwide. Patients undergoing major orthopedic surgery, total knee arthroplasty (TKA), and total hip arthroplasty (THA) are at high risk for developing VTE, which can manifest as deep vein thrombosis (DVT) or pulmonary embolism (PE), and PE can be life-threatening. It is a preventable complication of in-hospital mortality. The prophylaxis to prevent VTE varies from vitamin K antagonists like warfarin, low molecular weight heparin like enoxaparin, Fondaparinox sodium, direct factor Xa inhibitor like rivaroxaban and apixiban, mechanical thromboprophylaxis. Materials and Methods: Presented is a prospective study to see the efficacy of Oral rivaroxaban 10mg once daily dose for 14 days in the prevention of VTE in 60 elective cases total knee arthroplasty. The study was done from June 2017- October 2018 in the department of orthopaedics, Prathima institute of medical sciences, Nagunur, Karimnagar. All the operated cases were cemented with cruciate retaining prosthesis. Oral Rivaroxaban 10mg was given after 6-8 hours after wound closure and continued for 14 days. All the patients were closely monitored for signs and symptoms of DVT, PE with Wells DVT score followed by venous angiogram and signs of pulmonary embolism evaluated with modified Gurd and Wilson criteria and subsequent CT pulmonary angiogram. Results: In study involving 60 primary total knee replacement cases, only one patient developed deep venous thromboembolism (1.6%) with oral Rivaroxaban. No cases of bleeding manifestations or pulmonary embolism were reported. Conclusion: once daily oral dose of rivaroxaban 10mg for 14 days is an effective modality in preventing the number of cases of VTE after Total knee arthroplasty. The ease of administration of oral agents compared to subcutaneously given agents like Enoxaparin will lead to better patient compliance and early discharge from hospital.
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Vavilala Abhilash Rao (2020) studied this question.
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