The Safety And Efficacy Of Rivaroxaban After Joint Arthroplasty:A Meta-analysis

Objectives:To evaluate the efficacy and safety of rivaroxaban(an Xa-factor inhibitor)in prevention of hemorrhage and venous thrombus after total hip arthroplasty or knee arthroplasty.Methods:Databases including Pubmed,Elsevier,Science Direct,Web of Science,Google scholar,Baidu scholar were searched from inception to December 2016.All relevant studies reporting the efficacy and safety of rivaroxaban versus enoxaparin on total hip or knee arthroplasty were searched.The incidence rates of massive hemorrhage,minor hemorrhage,total hemorrhage,mortality of patients,deep venous thrombus,and pulmonary embolism following arthroplasty were extracted and analyzed between these two drugs.Results:Totally 11 articles were involved,including 9 RCTs and 2 cohort studies,9634 patients in group of rivaroxaban and 8242 patients in group of enoxaparin.Meta-analysis shows the treatment of rivaroxaban versus enoxaparin after total knee arthroplasty and total arthroplasty leads to significantly higher incidence rates of massive hemorrhage and total hemorrhage,insignificant differences in the incidence rates of minor hemorrhage,pulmonary embolism and death,and significantly lower incidence rate of lower-limb deep venous thrombus.Conclusions:The use of rivaroxaban can significantly reduce the incidence rate of VTE and DVT after total hip or total knee arthroplasty,but modestly increase the risks of postoperative hemorrhage.