David Gomez1, Helen Razmjou2, Andrea Donovan3, Vikas B Bansal4, Jeffrey D Gollish5, John J Murnaghan6. 1. Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada. 2. Department of Rehabilitation, Sunnybrook Health Sciences Centre, Toronto, Canada; Musculoskeletal Research, Sunnybrook Health Sciences Centre, Toronto, Canada. 3. Department of Diagnostic Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada. 4. Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada. 5. Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Holland Orthopaedic and Arthritic Center, Toronto, Canada. 6. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Holland Orthopaedic and Arthritic Center, Toronto, Canada.
Abstract
BACKGROUND: Multiple randomized controlled trials have documented the effectiveness of rivaroxaban in the prevention of venous thromboembolism up to 1-month following total joint arthroplasty. However, the effectiveness and safety of rivaroxaban in the real-world setting, outside of the strict protocols used by randomized clinical trials, are unknown. METHODS: This was a prospective, observational, noninterventional, phase IV study of 3914 consecutive patients who underwent total joint arthroplasty from June 2010 to December 2012. Patients were treated with rivaroxaban 10 mg by mouth daily starting postoperative day 1 and continued for 15 days. Participants were followed up in clinic at 6 weeks and contacted by telephone at 12 weeks. The primary outcome of interest was symptomatic venous thromboembolism; secondary outcomes included bleeding events, transfusion requirements, and death. RESULTS: The incidence of symptomatic deep venous thrombosis at 3 months was 0.5% (n = 18). Only 1 deep venous thrombosis event occurred within 7 days of surgery. The incidence of symptomatic pulmonary embolism (PE) at 3 months was 0.7% (n = 28). Thirteen PEs (46%) occurred within 7 days of surgery. The rate of major bleeding while on prophylaxis was 0.1%. Only 5% of patients received a blood transfusion. No deaths were attributed to thromboembolic events. CONCLUSION: This prospective, observational, phase IV study demonstrates that rivaroxaban appears to protect patients against symptomatic PE and is not associated with major bleeding events when used in a real-world setting as described.
BACKGROUND: Multiple randomized controlled trials have documented the effectiveness of rivaroxaban in the prevention of venous thromboembolism up to 1-month following total joint arthroplasty. However, the effectiveness and safety of rivaroxaban in the real-world setting, outside of the strict protocols used by randomized clinical trials, are unknown. METHODS: This was a prospective, observational, noninterventional, phase IV study of 3914 consecutive patients who underwent total joint arthroplasty from June 2010 to December 2012. Patients were treated with rivaroxaban 10 mg by mouth daily starting postoperative day 1 and continued for 15 days. Participants were followed up in clinic at 6 weeks and contacted by telephone at 12 weeks. The primary outcome of interest was symptomatic venous thromboembolism; secondary outcomes included bleeding events, transfusion requirements, and death. RESULTS: The incidence of symptomatic deep venous thrombosis at 3 months was 0.5% (n = 18). Only 1 deep venous thrombosis event occurred within 7 days of surgery. The incidence of symptomatic pulmonary embolism (PE) at 3 months was 0.7% (n = 28). Thirteen PEs (46%) occurred within 7 days of surgery. The rate of major bleeding while on prophylaxis was 0.1%. Only 5% of patients received a blood transfusion. No deaths were attributed to thromboembolic events. CONCLUSION: This prospective, observational, phase IV study demonstrates that rivaroxaban appears to protect patients against symptomatic PE and is not associated with major bleeding events when used in a real-world setting as described.
Authors: Alma B Pedersen; Ina Trolle Andersen; Soren Overgaard; Anne Marie Fenstad; Stein Atle Lie; Jan-Erik Gjertsen; Ove Furnes Journal: Acta Orthop Date: 2019-05-07 Impact factor: 3.717