Venous Thromboembolism Reduced in Orthopedic Surgery With Rivaroxaban

PHILADELPHIA – The rate of venous thromboembolism (VTE) decreased by 33% among high-risk orthopedic joint surgery patients who received 10 mg of rivaroxaban daily, according to research presented at the American Association of Nurse Practitioners (AANP) 2017 National Conference.

Recent data from the RECORD trials have suggested that daily treatment with 10 mg of oral rivaroxaban is more effective than subcutaneous enoxaparin in orthopedic surgery patients. Therefore, Kim-Khue Dinh, CRNP, and Yogini Patel, PharmD, from the University of Pennsylvania, developed a protocol to demonstrate the efficacy of rivaroxaban in lowering the risk of VTE among orthopedic joint surgery patients.

The researchers conducted an evaluation of practices after reviewing VTE rates across the orthopedic service. Patients who had a history of VTE, a body mass index greater than 40, or those who received a bilateral joint replacement and did not meet exclusion criteria received 10 mg of rivaroxaban daily for 35 days postoperatively.

After implementation of this protocol, the VTE incidence rate among those who received the treatment was reduced by 33%. The researchers also observed no difference in bleeding events.

The investigators noted the importance of NPs in determining the ideal chemoprophylaxis agent for high-risk patients undergoing joint replacement surgery. “NPs are positioned to implement an innovative VTE prophylaxis protocol in collaboration with a pharmacist and orthopedic surgeon with the ultimate goal of balancing efficacy and safety while minimizing bleeding risks,” they wrote. “It is also essential for NPs to advocate for combined modalities such as early postoperative mobilization and use of mechanical prophylaxis to prevent thromboembolic complications.”

Reference

1. Dinh KK, Patel Y. Rivaroxaban as an effective anticoagulant for venous thromboembolism prevention after an elective and high-risk orthopaedic joint surgery. Presented at the American Association of Nurse Practitioners 2017 National Conference; June 20-25, 2017; Philadelphia.

This article originally appeared on Clinical Advisor