Comparison of the Results of Deep Venous Thrombosis Prophylaxis between Using Rivaroxaban or Aspirin Following Primary Total Hip and Knee Arthroplasties | ||||
| The Egyptian Orthopaedic Journal | ||||
| Volume 60, Issue 2, June 2025, Page 98-103 PDF (323.56 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/EOJ.2025.431787 | ||||
 View on SCiNiTO | ||||
| Author | ||||
Mahmoud Khairy 
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| Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Alexandria University, Alexandria, Egypt. | ||||
| Abstract | ||||
| Background Joint arthroplasty increases the risk of venous thromboembolism (VTE). VTE includes a wide scale of clinical presentations ranging from being asymptomatic, in most cases, to fatal pulmonary embolism. Both the American Academy of Orthopaedic Surgeons (AAOS) as well as the American College of Chest Physicians (ACCP) agree that routine prophylaxis must be used in all patients undergoing total hip and knee arthroplasties to lessen the risk of VTE. Pharmacological agents include aspirin, warfarin, low-molecular-weight heparins, factor Xa inhibitors, and direct thrombin inhibitors. Rivaroxaban is a direct factor Xa inhibitor and is currently recommended for use in VTE prophylaxis. Aspirin is an antiplatelet drug that prevent platelet aggregation and thrombus formation. Our study aimed to conclude if rivaroxaban and aspirin are both efficient to prevent VTE when given after primary total hip or knee replacement as a primary outcome and to measure the rate of complications that can occur following the administration of these drugs as a secondary outcome. Patients and Methods This prospective study was applied to 284 patients. Prior to surgery, all the patients were confirmed to get a free lower limbs venous Doppler with normal bleeding profile investigations. They were divided into two groups. The first group included 136 patients. Forty-four patients were prepared to have primary total hip replacement (THR), and 92 patients were prepared to have primary total knee replacement (TKR). The patients of this group were given a postoperative 10mg oral daily dose of rivaroxaban as a deep venous thrombosis (DVT) prophylaxis. The second group included 148 patients. Seventy-two patients were prepared to have primary THR and 76 patients were prepared to have primary TKR. The patients of this group were given a postoperative 81mg oral twice daily dose of aspirin. Rivaroxaban and aspirin were continued for 3 weeks for the TKR patients and 5 weeks for the THR patients. All patients were checked for risk of postoperative bleeding events and thrombotic complications. All the patients had new lower limbs venous Doppler study and bleeding profile investigations after termination of the anticoagulation therapy. At the end of follow-up period, at least 3 months, All the patients had new bleeding profile investigations. Results At the end of the follow-up period, all the patients in both groups were clinically free from VTE. In the rivaroxaban group, four (2.94%) patients had a silent DVT, which was discovered accidentally in the postoperative Doppler study, and the aspirin group, two (1.35%) patients had a silent DVT which was discovered accidentally in the postoperative Doppler study. In the rivaroxaban group, 18 (13.2%) patients had abnormal bleeding profile laboratory investigations (prothrombin activity <70%). Eight patients had no clinical manifestations, four patients had hemarthrosis, and six patients had severe bleeding. In the aspirin group, no patients complained of any bleeding complications or abnormal bleeding profile laboratory investigations. Conclusions: It is concluded that this study supported the previous series in the literature, which proved that both rivaroxaban and aspirin are highly effective in preventing VTE when used after hip and knee arthroplasties. They both have better patient compliance as they are taken through the oral route. However, aspirin has a lower cost and a lower risk of bleeding. | ||||
| Keywords | ||||
| Arthroplasty; Aspirin; Bleeding; Rivaroxaban; Venous thromboembolism | ||||
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