Safety and Efficacy of Rivaroxaban in Primary Total Hip and Knee Arthroplasty |
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| Institution: | 1. Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea;2. Division of Biostatistics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea;3. Department of Orthopedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, South Korea;1. Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota;2. Mayo Clinic Alix School of Medicine, Rochester, Minnesota;1. Department of Orthopaedics, Toowoomba Hospital, Darling Downs Health, Toowoomba, Queensland, Australia;2. School of Medicine, Rural Clinical School, University of Queensland, South Toowoomba, Queensland, Australia;3. Australian Orthopaedic Association National Joint Replacement Registry, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia;4. Epworth Clinical School, The University of Melbourne, Richmond, Victoria, Australia;5. Tamar Valley Orthopaedics, Launceston, Tasmania, Australia;6. Wakefield Orthopaedic Clinic, Adelaide, South Australia, Australia;7. Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia;1. Department of Orthopedics, Orthopedic Research Institute, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China;2. Department of Orthopedic Surgery, Peking Union Medical College Hospital, Beijing, China;3. Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China;4. School of Life Sciences, Tsinghua University, Beijing, China;5. Institute of Biomedical and Health Engineering (iBHE), Tsinghua Shenzhen International Graduate School, Shenzhen, China;6. Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China;7. Longwood Valley, Beijing, China;8. School of Medicine, Tsinghua University, Beijing, China;1. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;2. Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea |
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| Abstract: | BackgroundAn optimal venous thromboembolism prophylaxis agent should balance efficacy and safety. While rivaroxaban provides effective venous thromboembolism prophylaxis after total joint arthroplasty, it may be associated with higher rates of bleeding. This study aimed to compare the safety and efficacy of rivaroxaban to aspirin and enoxaparin.MethodsA large national database was queried for patients who underwent elective primary total hip (THA) or total knee arthroplasty (TKA) from January 2015 through December 2020 who received rivaroxaban, aspirin, or enoxaparin. Multivariate analyses were performed to assess the 90-day risk of bleeding and thromboembolic complications. Among TKA patients identified, 86,721 (10.8%) received rivaroxaban, 408,038 (50.8%) received aspirin, and 108,377 (13.5%) received enoxaparin. Among THA patients, 42,469 (9.5%) received rivaroxaban, 242,876 (54.5%) received aspirin, and 59,727 (13.4%) received enoxaparin.ResultsAfter accounting for confounding factors, rivaroxaban was associated with increased risk of transfusion (TKA: adjusted odds ratio aOR] = 2.58, P < .001; THA: aOR 1.64, P < .001), pulmonary embolism (TKA: aOR = 1.25, P = .007), and deep vein thrombosis (TKA: aOR = 1.13, P = .022) compared to aspirin. Compared to enoxaparin, rivaroxaban was associated with an increased risk of combined bleeding events (TKA: aOR = 1.07, P < .001, THA: aOR = 1.11, P < .001), but decreased risk of combined prothrombotic events (THA: aOR = 0.85, P = .036).ConclusionRivaroxaban chemoprophylaxis following TKA and THA was associated with an increased risk of bleeding and prothrombotic complications compared to aspirin and enoxaparin. |
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| Keywords: | rivaroxaban aspirin warfarin bleeding thromboembolism deep vein thrombosis |
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