Efficacy and safety of thromboprophylaxis with low-molecular-weight heparin or rivaroxaban in hip and knee replacement surgery

Jan Beyer-Westendorf; Jörg Lützner; Lars Donath; Luise Tittl; Holger Knoth; Oliver C. Radke; Eberhard Kuhlisch; Thoralf Stange; Albrecht Hartmann; Klaus-Peter Günther; Norbert Weiss; Sebastian Werth

doi:10.1160/TH12-07-0510

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2013; 109(01): 154-163
DOI: 10.1160/TH12-07-0510

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Efficacy and safety of thromboprophylaxis with low-molecular-weight heparin or rivaroxaban in hip and knee replacement surgery

Findings from the ORTHO-TEP registry

Jan Beyer-Westendorf

¹Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital “Carl Gustav Carus” Dresden, Dresden, Germany

,

Jörg Lützner

²Clinic of Orthopaedic Surgery, University Hospital “Carl Gustav Carus” Dresden, Dresden, Germany

,

Lars Donath

¹Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital “Carl Gustav Carus” Dresden, Dresden, Germany

,

Luise Tittl

¹Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital “Carl Gustav Carus” Dresden, Dresden, Germany

,

Holger Knoth

³Pharmacy Department, University Hospital “Carl Gustav Carus” Dresden, Dresden, Germany

,

Oliver C. Radke

³Pharmacy Department, University Hospital “Carl Gustav Carus” Dresden, Dresden, Germany

,

Eberhard Kuhlisch

⁵Institute for Medical Informatics and Biometry, Technical University Dresden, Germany

,

Thoralf Stange

⁵Institute for Medical Informatics and Biometry, Technical University Dresden, Germany

,

Albrecht Hartmann

²Clinic of Orthopaedic Surgery, University Hospital “Carl Gustav Carus” Dresden, Dresden, Germany

,

Klaus-Peter Günther

²Clinic of Orthopaedic Surgery, University Hospital “Carl Gustav Carus” Dresden, Dresden, Germany

,

Norbert Weiss

¹Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital “Carl Gustav Carus” Dresden, Dresden, Germany

,

Sebastian Werth

¹Center for Vascular Medicine and Department of Medicine III, Division of Angiology, University Hospital “Carl Gustav Carus” Dresden, Dresden, Germany

› Institutsangaben

Abstract

Summary

Prospective trials have shown that rivaroxaban thromboprophylaxis is superior over low-molecular-weight heparin (LMWH) in patients undergoing hip and knee replacement surgery. However, patients treated under trial conditions are different from unselected routine patients, which may affect efficacy and safety of thromboprophylaxis. The objective was to evaluate the efficacy and safety of rivaroxaban or LMWH thromboprophylaxis in unselected patients undergoing hip and knee replacement surgery in daily care. In a monocentric, retrospective cohort study in 5,061 consecutive patients undergoing hip and knee replacement surgery a comparison of LMWH (hospital standard in 2006–2007) and rivaroxaban (since 2009) was made with regard to rates of symptomatic VTE, bleeding and surgical complications and length of hospital stay. Rates of symptomatic VTE were 4.1 % (LMWH) and 2.1 % (rivaroxaban; p=0.005) with rates for distal DVT 2.5 vs. 1.1 % (p<0.001). Rates of major VTE were numerically higher with LMWH (1.7 vs. 1.1%, not statistically significant). Rates of major bleeding (overt bleeding leading to surgical revision or death, occurring in a critical site, or transfusion of at least two units of packed red blood cells) were statistically lower with rivaroxaban (2.9 vs. 7.0%; p<0.001). Rivaroxaban patients had fewer surgical complications (1.1 vs. 3.7%; p<0.001) and a shorter length of hospitalisation (8.3 days; 95% CI 8.1– 8.5 vs. 11.1 days; 10.7– 11.5; p< 0.001). We conclude that rivaroxaban thromboprophylaxis is more effective than LMWH in unselected patients undergoing hip and knee replacement surgery in daily care and that switching from LMWH to rivaroxaban could be beneficial. Prospective comparisons are warranted to confirm our findings.

Keywords

Low-molecular-weight heparin - major orthopaedic surgery - rivaroxaban - venous thromboembolism - VTE prophylaxis

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Referenzen

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