Key result
Enoxaparin was associated with significantly increased odds of bleeding compared to aspirin following lower extremity joint arthroplasty or revision (1.80% vs 0.99%; OR 1.18; 95% CI 1.01-1.38; p=0.042).
Why the study?
Rivaroxaban, enoxaparin, and aspirin prevent venous thromboembolism after lower extremity joint arthroplasty or revision, but their comparative bleeding risk remains poorly understood.
Does rivaroxaban or enoxaparin increase bleeding compared to aspirin in patients undergoing hip or knee arthroplasty or revision?
Population
85,938 patients who underwent hip or knee arthroplasty or revision across 148 US facilities
Comparison
Enoxaparin vs rivaroxaban vs aspirin monotherapy for thromboprophylaxis
Design
3-year retrospective cohort study
Follow-up
40 days following surgery
Authors
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May support aspirin preference to minimize bleeding after arthroplasty; hypothesis-generating and requires RCT confirmation before practice change.
Cohort (n=85,938)
Yes
Does rivaroxaban or enoxaparin increase bleeding compared to aspirin in patients undergoing hip or knee arthroplasty or revision?
Odds Ratio: 1.18 (95% CI 1.01–1.38)
Absolute Event Rate: 1.8% vs 0.99%
p-value: p=0.042
Aspirin is associated with significantly decreased odds of bleeding complications compared to enoxaparin for postoperative thromboprophylaxis following lower extremity joint arthroplasty.
Watts et al. (2021) conducted a cohort in Hip or knee arthroplasty or revision (n=85,938). Enoxaparin vs. Aspirin was evaluated on All bleeding, classified as major or minor bleeding, occurring in the 40 days following surgery (OR 1.18, 95% CI 1.01-1.38, p=0.042). Enoxaparin was associated with significantly increased odds of bleeding compared to aspirin following lower extremity joint arthroplasty or revision (1.80% vs 0.99%; OR 1.18; 95% CI 1.01-1.38; p=0.042).
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