COMPARATIVE STUDY OF RIVAROXABAN WITH ENOXAPARIN AS THROMBO PROPHYLAXIS IN TOTAL HIP REPLACEMENT
DOI:
https://doi.org/10.59058/jaimc.v20i4.54Keywords:
Thrombo prophylaxis, Enoxaparin, Rivaroxaban, Hip Athroplasty, Knee arthroplasty.Abstract
Background and Objectives: In total Hip arthroplasty, thromboembolism prophylaxis is a standard practice with minimal recommended duration of ten days. Thromboembolism prevention leads to reduction in symptomatic venous thromboembolic complications without risk of major bleeding.The objective of the study was to assess and compare the efficacy of oral rivaroxaban with subcutaneous enoxaparin for prevention of thromboembolism after total hip and total knee replacement.
Methods: It was a Randomized Control Trial conducted at Department of Orthopedic Surgery, Services Hospital Lahore. After permission from the Institutional review board, a total number of 200 patients who underwent total hip replacement (THR) were enrolled in the study. These patients were divided into 2 equal groups A and B, each group having 100 patients. In Group A, all the patients were given Rivaroxaban 10 mg daily while in Group B Enoxaparin 40mg s/c was given. In all the patients’ anticoagulant prophylaxis was started 3-5 days before the surgery and 7-10 days after the surgery during Hospital stay.
Results:Group A where all patients were given Tab Rivaroxaban 10mg daily, did not show any signs of DVT in the final follow up while In patients of Group B DVT occurred in 2 patients (2%) during the 1st week post operatively. This shows that Rivaroxaban causes lower incidence of thromboembolism when compared to enoxaparin (RR0.70 & CI95%).
Conclusion: Rivaroxaban showed better anticoagulant effects than enoxaparin. It has slight higher risk of bleeding than enoxaparin. Direct factor Xa inhibitors are effective to prevent thromboembolism after total hip and total knee replacement. The anticoagulant effects are not necessarily compromised with risk of high bleeding.
References
Manista Gc et al. Anticoagulants in Revision Total joint Arthoplasty: A Retrospective review of 1917 cases. Orthopaedics 2019 Nov 1; 42: 323-329
A. Shahi, A.F. Chen, T.L.Tan, M.G. Mattenfort, F. Kucukdurmaz, and J. Parvizi “ the incidence and economic burden of in-hospital and venous thromboembolism in united states”. The J arthroplasty ;32(4):1063-1066
B. Stefano et al. Early Discharge And Home Treatment With Low Risk Pulmonary Embolism with Oral Factor Xa Inhibitors Rivaroxaban: an international multicenter single-arm Clinical trial. Eur Heart J 2020; 14(4):509-518.
Jenny JY, Papinger I, Samama CM. European Guidelines on perioperative Venous Thromboembolism Prophylaxis: Aspirin. Eur J Anaesthesiol 2018; 35(2) : 123-129
Cote MP, Chen A, Jiang Y, Chen V, Pulmonary embolism rate after Total Knee Arthroplasty even with prophylactic anticoagulants. J Arthroplasty 2017; 32(12): 3833-9
EINSTENI Investigators et al. Oral Rivaroxaban for Symptomatic Venous Thromboembolism. N Engl J Med 2010 ; 363(26): 2499-2510
DA Flevas et al. Thromboembolism prophylaxis in Orthopaedics: an update. EFORT Open Rev 2018; 31: 13-142
S Thiengwittayaporn, B. Nicolas et al. Asia-Pacific Venous Thromboembolism consensus in knee and hip Arthroplasty. Knee Surg & Relt Res 2021; 33(24)
riksson BI, Borris LC, Friedman RJ, Haas S, Huisman MV, Kakkar AK, Bandel TJ, Beckmann H, Muehlhofer E, Misselwitz F, Geerts W; RECORD1 Study Group. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med. 2008 Jun 26;358(26):2765-75.
Ander DR et al; American Society of Hematology 2019 guidelines for management of Venous Thromboembolism: Prevention of Venous Thromboembolism in surgical hospitalized patients. Blood Adv 2019; 3(23): 3898-3944
Wendelboc AM, Raskob GE. Global burden of Thrombosis: Epidemiological Aspects. Circ Res 2016; 118: 1340-1347
Xie J, Maj, Huang Q et al. Comparison of Enoxaparin and Rivaroxaban in balance of antifibrinolysis and anticoagulation following total knee replacement. A pilot study. Med Sci Mmit 2017; 23:704-11.
W-Beyer, P Mouret, AGG Turpie; Rivaroxaban for Venous thromboembolism prevention after major Orthopaedic Surgery: Translating Trial Date into routine clinical practice. Orthop Res & Rev 2017; 9: 1-11
Runner RP et al. utilization, pattern, efficacy and complication of Thromboembolism Prophylaxis Strategies in primary hip and knee Arthroplasty as reported by American Broad of orthopaedic Surgery. J Arthroplasty 2019; 34(4): 729-734
J Liu et al; effectiveness and safety of Rivaroxaban for prevention of thrombosis following Total hip or knee replacement: a systematic review and meta analysis. Medicines 2019: 98-9
F.H. Haung et al. Rivaroxaban vs Enoxaparin for prevention of thromboembolism after total knee arthroplasty, a meta analysis. Medicine : Nov 2018 vol 97 issue 48 Pe 13465.
Ning GZ, Kan SL, Chen Lx et al. Rivaroxaban for thrombo prophylaxis after Total hip or Knee arthroplasty: a meta analysis with trial sequential analysis of randomized control trials. Sci Rep 2016;6:23726.
Momin J. H. Candidate P; Hughes G. J. Andexanet alfa(Andexxa) for reversal of direct anticoagulants. Pharmacy and Therapeutics 2019; 44: 530-549
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Muhammad Zafar Iqbal Shahid, Muhammad Khalid, Tanveer Haider, Muhammad Siddique Hamid, Muhammad Khalid Syed, Asim Islam
This work is licensed under a Creative Commons Attribution 4.0 International License.
The articles published in this journal come under creative commons licence Attribution 4.0 International (CC BY 4.0) which allows to copy and redistribute the material in any medium or format Adapt — remix, transform, and build upon the material for any purpose, even commercially under following terms.
-
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
The editorial board of the Journal strives hard for the authenticity and accuracy of the material published in the Journal. However, findings and statements are views of the authors and do not necessarily represent views of the Editorial Board. Many software like (Google Maps, Google Earth, Biorender (free version)) restricts the free distribution of materials prepared using these softwares. Therefore, authors are strongly advised to check the license/copyright information of the software used to prepare maps/images. In case of publication of copyright material, the correction will be published in one of the subsequent issues of the Journal, and the authors will bear the printing cost.
