Key result
Rivaroxaban prophylaxis after total hip arthroplasty was associated with a higher incidence of deep venous thrombosis compared to enoxaparin (10% vs 0%; p=0.04).
Why the study?
Total hip arthroplasty carries a significant risk of venous thromboembolism, prompting comparison of the efficacy and safety of rivaroxaban versus enoxaparin.
Does rivaroxaban reduce the incidence of VTE compared to enoxaparin in patients undergoing total hip arthroplasty?
RCT (n=160)
randomized
Does rivaroxaban reduce the incidence of VTE compared to enoxaparin in patients undergoing total hip arthroplasty?
Answers are grounded in this paper and cite their sources.
In patients undergoing total hip arthroplasty, rivaroxaban was associated with a higher incidence of DVT compared to enoxaparin, suggesting lower efficacy in this cohort.
Propose: Total hip arthroplasty (THA) is associated with a significant risk of venous thromboembolism (VTE). Different thromboprophylaxis strategies have been used to prevent VTE. The primary aim of this study was to report the incidence of VTE and compare the efficacy and safety of rivaroxaban to enoxaparin. The secondary outcome was to report the incidence of silent deep venous thrombosis (DVT) using computed tomography venography. Methods: One hundred sixty patients who underwent THA were enrolled in a prospective study. Patients were randomized into two groups as follows: those who received rivaroxaban 10 mg oral daily (group RXE) and those who received enoxaparin 40 IU/day subcutaneously for 14 days (group ENO). Results: Both groups were matched for age, sex, comorbidities, special habits and preoperative laboratory investigations. The overall incidence of DVT was 5% ( n = 8), which included four patients clinically diagnosed as having DVT and four with silent DVT. All the DVT cases occurred in veins below the knee and in the group RXE; none of the cases occurred in group ENO ( p = 0.04). The incidence of DVT was significantly higher in patients with high body mass indexes ( p < 0.001), older age ( p = 0.024) and medical comorbidities ( p = 0.14). No mortality, pulmonary embolism, stroke, wound infection or major bleeding occurred in either group. Conclusions: Among the patients who underwent hip arthroplasty, rivaroxaban prophylaxis was found to be associated with lower efficacy and similar safety outcomes as compared with enoxaparin anticoagulants.
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Rahman et al. (2020) conducted an RCT in Total hip arthroplasty (n=160). Rivaroxaban vs. Enoxaparin 40 IU/day subcutaneously was evaluated on Incidence of venous thromboembolism (deep venous thrombosis) (p=0.04). Rivaroxaban prophylaxis after total hip arthroplasty was associated with a higher incidence of deep venous thrombosis compared to enoxaparin (10% vs 0%; p=0.04).
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