Rivaroxaban versus Enoxaparin for thromboprophylaxis after total hip or knee replecement.

Abstract

Venous Thromboembolism (VTE), which comprises both Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE), is a cause of significant mortality and morbidity worldwide in patients undergoing joint surgery (Geerts et al, 2008; Hyers, 2003). This dissertation will review the evidence regarding the use of thrombophylaxis in the prevention of VTE after TKR and THR and will determine the best evidence-based approach to treatment. The lack of guidelines and several variations in prescribing thromboprophylaxis triggered the formulation of this question, "In postoperative Orthopaedic patients undergoing joint surgery (P), are Rivaroxaban tablets (I) more effective than an Enoxaparin injection (C) in preventing venous thrombosis(O)?" A literature search was conducted from electronic databases which were provided by the University of Malta Library, Google scholar and from the Elsevier Orthopaedic Journals. The main keywords used include; "Rivaroxaban", "Enoxoparin", "Rivaroxaban VS Enoxoparin in DVT", "Preventing deep vein thrombosis", "Rivaroxaban VS Enoxoparin", "DVT" and "Enoxoparin". An exclusion criteria was established including; descriptive studies on DVT, cost effectiveness analysis, editorials and studies which considered other prophylactic measures such as stockings. The inclusion criteria incorporated studies published from 2000 to 2011, in the English language, and including all the PICO elements. The search revealed a SR and four RCTs. Methods of appraisal were used from the Critical Appraisal Skill Programme (CASP) tools from the Public Health Resources Unit (2006). Findings revealed that a once daily, 10 mg Rivaroxaban tablet was significantly more effective for extended thromboprophylaxis than a once-daily, 40mg Enoxaparin injection in patients undergoing THR and TKR for the prevention of DVT and VTE. Administration of Rivaroxaban is also pain free unlike Enoxaparin which needs to be administered subcutaneously. Recommendations included patient and hospital staff education on the importance of Rivaroxaban use in preventing DVT. The need for the development of hospital guidelines is recommended which should be developed together with the hospital team for the benefit of the patient.