A systematic review of rivaroxaban versus enoxaparin in the prevention of venous
thromboembolism after hip or knee replacement.
Author(s): Turun S, Banghua L, Yuan Y, Zhenhui L, Ying N, Jin C.
Affiliation(s): West China Hospital/West China medical school, Sichuan University, Chendu, China.
Publication date & source: 2011, Thromb Res. , 127(6):525-34
INTRODUCTIONS: Rivaroxaban is a novel Xa inhibitor with an encouraging
anti-thrombosis effect. The aim of this study is to assess whether rivaroxaban is
superior to enoxaparin in venous thromboembolism prevention after knee- or
hip-joint replacement.
MATERIALS AND METHODS: We searched for reports of randomized controlled trials on
rivaroxaban versus enoxaparin in venous thromboembolism prophylaxis after knee-
or hip-joint replacement in the Cochrane library, Embase, Pubmed, the Ovid
database, and Chinese databases including VIP, CNKI, and CBM. Correlated data was
extracted and analyzed.
RESULTS: Eight studies involving 15246 patients were included, and all were
randomized controlled studies. The methodological quality of six of the trials
was generally moderate, while that of the remaining two was considered high
quality. 10mg rivaroxaban daily is more effective than 40 mg/30 mg enoxaparin
daily after the joint replacement in respect of the incidence of venous
thromboembolism (P < 0.0001, RR = 0.38; P = 0.05, RR = 0.77, respectively). No
significant difference between 10mg rivaroxaban daily and 40 mg/30 mg enoxaparin
daily were found in major postoperative bleeding (P = 0.45, RR = 1.31;P = 0.34,
RR = 1.61, respectively). With respect to other outcomes, rivaroxaban is not
inferior to enoxaparin, while extended therapy with rivaroxaban (>30 d) is more
effective than short-term therapy (<15 d) in relation to the incidence of venous
thromboembolism (1.36% versus 10.13%).
CONCLUSIONS: Rivaroxaban is superior to enoxaparin in venous thromboembolism
prophylaxis after hip- or knee-joint replacement. Extended therapy--longer than
30 d--is recommended.
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