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Meta-Analysis
. 2018 Nov;97(48):e13465.
doi: 10.1097/MD.0000000000013465.

Rivaroxaban versus enoxaparin for the prevention of venous thromboembolism after total knee arthroplasty: A meta-analysis

Hai-Feng Huang  1   2 , Shan-Shan Li  3 , Xian-Teng Yang  1   2 , Quan Xie  4 , Xiao-Bin Tian  2
Affiliations
Meta-Analysis

Rivaroxaban versus enoxaparin for the prevention of venous thromboembolism after total knee arthroplasty: A meta-analysis

Hai-Feng Huang et al. Medicine (Baltimore). 2018 Nov.

Abstract

Objective: This article analyzed the clinical efficacy and tolerability of rivaroxaban and enoxaparin in patients undergoing total knee arthroplasty (TKA) surgery.

Methods: Five randomized, controlled clinical trials on rivaroxaban versus enoxaparin in patients who underwent TKA were identified and included in this meta-analysis.

Results: The meta-analysis indicated that rivaroxaban prophylaxis was associated with lower rates of symptomatic venous thromboembolism (VTE) (relative risk[RR]:0.55; 95% confidence interval [CI]: 0.35-0.86; P = .009), symptomatic deep vein thrombosis (DVT) (RR 0.44, 95% CI 0.25-0.80, P = .007), asymptomatic DVT (RR: 0.57; 95% CI: 0.37-0.89; P = .01), distal DVT (RR: 0.62; 95% CI: 0.45-0.85; P = .003) and proximal DVT (RR: 0.42; 95% CI: 0.24-0.75; P = .004). Compared with the enoxaparin group, the incidence of symptomatic pulmonary embolism (PE) (RR: 0.48; 95% CI: 0.19-1.24; P = .13) in the rivaroxaban group was not significantly different. A nonsignificant trend towards all-cause death (RR: 0.38; 95% CI: 0.03-4.92; P = .46) or major bleeding (RR: 1.59; 95% CI: 0.77-3.27; P = .21) risk between rivaroxaban and enoxaparin prophylaxis was found.

Conclusion: Compared with the enoxaparin group, the group using rivaroxaban after TKA had a significantly lower rate of symptomatic VTE, symptomatic DVT, asymptomatic DVT, distal DVT, and proximal DVT. Our study shows that rivaroxaban after TKA is more effective than enoxaparin and did not increase major bleeding or all-cause mortality.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram of the inclusion of studies for the meta-analysis.
Figure 2
Figure 2
Risk of bias of the selected studies according to the Cochrane Collaboration tool. Panel A: Risk of bias graph; the judgment regarding each risk of bias item is presented as a percentage across all studies. Panel B: Risk of bias summary; the judgment regarding each risk of bias item for each study. (+), low risk of bias; (-), high risk of bias; (?), unclear risk of bias.
Figure 3
Figure 3
Rivaroxaban versus enoxaparin: symptomatic venous thromboembolism after total knee arthroplasty.
Figure 4
Figure 4
Rivaroxaban versus enoxaparin: symptomatic deep vein thrombosis after total knee arthroplasty.
Figure 5
Figure 5
Rivaroxaban versus enoxaparin: symptomatic pulmonary embolism after total knee arthroplasty.
Figure 6
Figure 6
Rivaroxaban versus enoxaparin: asymptomatic deep vein thrombosis after total knee arthroplasty.
Figure 7
Figure 7
Rivaroxaban versus enoxaparin: distal deep vein thrombosis after total knee arthroplasty.
Figure 8
Figure 8
Rivaroxaban versus enoxaparin: proximal deep vein thrombosis after total knee arthroplasty.
Figure 9
Figure 9
Rivaroxaban versus enoxaparin: major bleeding after total knee arthroplasty.
Figure 10
Figure 10
Rivaroxaban versus enoxaparin: all-cause mortality after total knee arthroplasty.
See this image and copyright information in PMC

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