Clinical outcomes observed with Rivaroxaban versus low molecular weight heparin (Enoxaparin) for thrombo-prophylaxis following total knee arthroplasty: a meta-analysis.

INTRODUCTION

In this analysis, we aimed to systematically compare the clinical outcomes observed with rivaroxaban versus low molecular weight heparin (LMWH) [enoxaparin] for thrombo-prophylaxis following total knee arthroplasty (TKA).

METHODS

Relevant studies based on rivaroxaban versus LMWH for thrombo-prophylaxis following TKA were searched through online databases. Data sources were MEDLINE, EMBASE, Cochrane database, Google scholar, www.

CLINICALTRIALS: gov and Web of Science. Nine studies with a total number of 26,675 participants were included. Clinical outcomes (adverse efficacy and bleeding outcomes) were considered as the endpoints in this analysis. The Revman software was used for data analysis. Risk ratios (RR) with 95% confidence intervals (CI) were used to represent the results.

RESULTS

A total number of 26,675 participants were included in this analysis whereby 13,496 participants were assigned to rivaroxaban and 13,179 participants were assigned to LMWH. Our current results showed that deep venous thrombosis (RR: 0.60, 95% CI: 0.51 - 0.71; P = 0.00001), venous thromboembolism (RR: 0.56, 95% CI: 0.45 - 0.70; P = 0.00001), and all-cause mortality (RR: 0.54, 95% CI: 0.33 - 0.87; P = 0.01) were significantly lower with rivaroxaban compared to LMWH for thrombo-prophylaxis after TKA. Adverse cardiac events (RR: 1.50, 95% CI: 0.53 - 4.21; P = 0.44) were similarly manifested. However, any bleeding event (RR: 1.18, 95% CI: 1.07 - 1.31; P = 0.001), major bleeding (RR: 1.54, 95% CI: 1.12 - 2.11; P = 0.008), non-major bleeding (RR: 1.15, 95% CI: 1.01 - 1.30; P = 0.03), minor bleeding (RR: 1.19, 95% CI: 1.06 - 1.32; P = 0.002) and bleeding leading to re-operation (RR: 1.62, 95% CI: 1.08 - 2.44; P = 0.02) were significantly higher with rivaroxaban when compared to LMWH.

CONCLUSION

Our analysis showed that rivaroxaban when used as thrombo-prophylaxis following TKA, significantly reduced thrombotic outcomes when compared to LMWH. However, the risks of bleeding events including major and minor bleeding events were significantly increased in comparison to LMWH. Therefore, further larger studies should be able to confirm our hypothesis.