Rivaroxaban Then Aspirin vs. Aspirin Alone after Total Hip or Knee Arthroplasty.
Sudeep Shivakumar, Davide Matino, David Zukor et al.
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In 30 seconds
This multicenter, double-blind randomized controlled trial compared aspirin alone with rivaroxaban followed by aspirin for thromboprophylaxis after total hip or knee arthroplasty. Patients received either 81 mg aspirin or 10 mg rivaroxaban daily for 5 days, then aspirin; follow-up for symptomatic venous thromboembolism and bleeding was 90 days. Symptomatic venous thromboembolism occurred in 13 of 2718 patients (0.48%) with aspirin alone and 12 of 2647 (0.45%) with rivaroxaban-aspirin. Aspirin alone met the prespecified criterion for noninferiority, with no clinically relevant difference in bleeding events.
Key findings
- Symptomatic venous thromboembolism occurred in 13 of 2718 patients (0.48%) with aspirin alone versus 12 of 2647 (0.45%) with rivaroxaban-aspirin.
- The risk difference for venous thromboembolism was 0.02 percentage points (95% confidence interval [CI], -0.34 to 0.39; P<0.001 for noninferiority).
- Major or clinically relevant nonmajor bleeding occurred in 45 of 2718 patients (1.66%) with aspirin alone and 54 of 2647 (2.04%) with rivaroxaban-aspirin.
Why it matters
Venous thromboembolism prevention is an important part of care after hip and knee arthroplasty. In this randomized comparison, aspirin from the outset was noninferior to an initial 5-day course of rivaroxaban followed by aspirin for preventing symptomatic events, while bleeding outcomes showed no clinically relevant difference. These results inform evaluation of postoperative thromboprophylaxis strategies in the studied population.