Venous Thromboembolism Prevention After Joint Arthroplasty With Rivaroxaban or Aspirin

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After receiving total hip or knee arthroplasty, patients were randomly assigned to either aspirin or rivaroxaban for VTE prevention.
After receiving total hip or knee arthroplasty, patients were randomly assigned to either aspirin or rivaroxaban for VTE prevention.

HealthDay News — For patients who have undergone total hip or knee arthroplasty, extended prophylaxis with aspirin does not differ significantly from rivaroxaban for venous thromboembolism prevention, according to a study published in the New England Journal of Medicine.

David R. Anderson, MD, from Dalhousie University in Halifax, Canada, and colleagues conducted a multicenter randomized trial involving patients who were undergoing total hip (1804 patients) or knee (1620 patients) arthroplasty. All patients received oral rivaroxaban until postoperative day 5 and were then randomly assigned to continue rivaroxaban or switch to aspirin for 9 or 30 days after total knee or total hip arthroplasty, respectively. Patients were followed for 90 days.

The researchers found that venous thromboembolism occurred in 0.64% and 0.7% of patients in the aspirin and rivaroxaban groups, respectively (difference, 0.06 percentage points; 95% CI, −0.55 to 0.66; P < .001 for noninferiority and P = .84 for superiority). 

Major bleeding complications occurred in 0.47% and 0.29% of patients in the aspirin and rivaroxaban groups, respectively (difference, 0.18 percentage points; 95% CI, −0.65 to 0.29; P =.42). Clinically important bleeding occurred in 1.29% and 0.99% of patients in the aspirin and rivaroxaban groups, respectively (difference, 0.3 percentage points; 95% CI, −1.07 to 0.47; P = .43).

"Extended prophylaxis with aspirin was not significantly different from rivaroxaban in the prevention of symptomatic venous thromboembolism," the authors wrote.

Disclosures: Several authors disclosed financial ties to the pharmaceutical industry.

Reference

Anderson DR, Dunbar M, Murnaghan J, et al. Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty [published online February 22, 2018. N Engl J Med. doi:10.1056/NEJMoa1712746

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