Page 4 - OrthoFeed issue3 - Final

Thromboprophylaxis

Rivaroxaban versus Aspirin in Prevention

of Venous Thromboembolism

Dr. Hemant K.Kalyan 4.00.%
3.50%
HOD, Departments of Orthopaedic Surgery & 3.50%
Sports Medicine 3.00%
Manipal Hospital, Bangalore 2.50%
2.00%
1.50% 1.30%
Introduction 1.00%
Thromboprophylaxis represent one of the greatest benefits 0.50% 0.40%
offered to a patient requiring total hip arthroplasty (THA) 0.30% 0.30% 0.30%
0.00%
or total knee arthroplasty (TKA). [1] Aspirin Rivaroxaban
The choice of an appropriate pharmacological agent for Reduction in VTE Incidence of major bleeding All-cause mortality
prophylaxis relies on the balance between efficacy in the Figure 1- Comparing the efficacy of aspirin and rivaroxaban in the prevention of VTE [3]
prevention of venous thromboembolism (VTE) and the risk
of bleeding. [1] Conclusion
Clinical trials have proven that the preventive effect of
Aspirin vs Rivaroxaban rivaroxaban on VTE is more potent than that of aspirin.

SIGN (Scottish Intercollegiate Guidelines Network)
Parameter Aspirin Rivaroxaban
guidelines also recommend rivaroxaban over aspirin for
Action Antiplatelet Selective direct the prevention of VTE in adults post THA/TKA. (Grade A) [2]
aggregation effect inhibition of factor Xa
enabling the with high
prevention of VTE. [1] bioavailability. [1]
References

Scientific Lack of definitive Phase III, double-blind 1. Luiz Eugênio Garcez Leme, Guilherme Turolla Sguizzatto.
evidence evidence of its action clinical trials known as Prophylaxis of Venous Thromboembolism in Orthopaedic
as a prophylactic RECORD has proven its Surgery. Rev Bras Ortop. 2015 Nov 4;47(6):685-93.
agent for VTE. [2] efficacy in the prevention
of VTE after THA/TKA. [1] 2. Flevas et al. Thromboembolism prophylaxis in orthopaedics:
an update. EFORT Open Rev 2018;3:136-148.
3. Xie J, Jiang M, Lin Y, Deng H, Xie X, Li L. Rivaroxaban versus
Real world evidence Aspirin in Prevention of Venous Thromboembolism: A
A meta-analysis was conducted on 9 trials involving a total Meta-Analysis of 9 Randomized Controlled Trials comprising
of 7,656 patients to compare the efficacy of aspirin and 7,656 Patients. Thromb Haemost. 2019;119(9):1517-1526.
rivaroxaban in the prevention of VTE. [3]

Compared with aspirin, rivaroxaban significantly reduced
VTE (1.3% vs. 3.5%) while having no significant differences
in the incidence of major bleeding (0.3% vs. 0.4%) and
all-cause mortality (0.3% vs. 0.3%) (Figure 1) [3]
Rivaroxaban demonstrated a significant reduction in the
incidence of VTE after THA and TKA at both 10mg and 20
mg dosage compared with aspirin (RR: 0.36, 95% CI,
0.25–0.51; RR: 0.35, 95% CI, 0.20–0.60) [3]