The efficacy and safety of rivaroxaban for venous thromboembolism prophylaxis after total hip and total knee arthroplasty

Abstract

Venous thromboembolism (VTE) is a common complication after total hip and total knee arthroplasty. Currently used methods of VTE prophylaxis after these procedures have important limitations, including parenteral administration, and unpredictable plasma levels requiring frequent monitoring and dose adjustment leading to decreased patient compliance with recommended guidelines. New oral anticoagulants have been demonstrated in clinical trials to be equally efficacious to enoxaparin and allow for fixed dosing without the need for monitoring. Rivaroxaban is one of the new oral anticoagulants and is a direct factor Xa inhibitor that has demonstrated superior efficacy to that of enoxaparin. However, the data also suggest that rivaroxaban has an increased risk of bleeding compared to enoxaparin. This paper reviews the available data on the efficacy and safety of rivaroxaban for VTE prophylaxis after total hip and total knee arthroplasty.

Figure 1

Pooled incidence of major plus clinically relevant non-major bleeding for RECORD trials 1–4. Patients taking rivaroxaban had more events than patients taking enoxaparin (P = 0.03). In subgroup analysis, more events occurred in patients taking rivaroxaban less than 65 years of age (P = 0.04), weighing less than 90 kg (P = 0.02), and with creatinine clearance over 80 mL/min (P = 0.005) [30].