Comparative Study of Rivaroxaban with Enoxaparin as Thrombo Prophylaxis in Total Hip Replacement

Abstract

Background and Objectives: In total Hip arthroplasty, thromboembolism prophylaxis is a standard practice
with minimal recommended duration of ten days. Thromboembolism prevention leads to reduction in
symptomatic venous thromboembolic complications without risk of major bleeding.To assess and compare
the efficacy of oral rivaroxaban with subcutaneous enoxaparin for prevention of thromboembolism after total
hip and total knee replacement.
Methods: It was a Randomized Control Trial conducted at Department of Orthopedic Surgery, Services
Hospital Lahore. After permission from the Institutional review board, a total number of 200 patients who
underwent either total hip replacement (THR) were enrolled in the study. These patients were divided into 2
equal groups Aand B, each group having 100 patients. In Group A, all the patients were given Rivaroxaban 10
mg daily while in Group B Enoxaparin 40mg s/c was given. In all the patients' anticoagulant prophylaxis was
started 3-5 days before the surgery and 7-10 days after the surgery during Hospital stay.
Results: In group A where all patients were given Tab Rivaroxaban 10mg daily, did not show any signs of
DVTin the final follow up. In Group B, DVToccurred in 2 patients (2%) during the 1st week post operatively.
This shows that Rivaroxaban causes lower incidence of thromboembolism when compared to enoxaparin.
Conclusion: Rivaroxaban showed better anticoagulant effects than enoxaparin. It has slight higher risk of
bleeding than enoxaparin. Direct factor Xa inhibitors are effective to prevent thromboembolism after total
hip and total knee replacement. The anticoagulant effects are not necessarily compromised with risk of high
bleeding..
Key Words: Thrombo prophylaxis, Enoxaparin, Rivaroxaban, Hip Athroplasty, Knee arthroplasty.