Comparison of the Efficacy and Safety of Rivaroxaban and Enoxaparin as Thromboprophylaxis Agents for Orthopedic Surgery—Systematic Review and Meta-Analysis
Venous thromboembolism (VTE) is a serious complication that can occur during and after postoperative treatment, including in treatment after orthopedic surgery. The current guidelines for VTE prophylaxis in postoperative patients recommend the use of LMWHs, one of which is enoxaparin. Another recomm...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/14/4070 |
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| author | Ikhwan Rinaldi Ihya Fakhrurizal Amin Yuli Maulidiya Shufiyani Idham Rafly Dewantara Brenda Cristie Edina Kevin Winston Yusuf Aji Samudera Nurrobi |
| author_facet | Ikhwan Rinaldi Ihya Fakhrurizal Amin Yuli Maulidiya Shufiyani Idham Rafly Dewantara Brenda Cristie Edina Kevin Winston Yusuf Aji Samudera Nurrobi |
| author_sort | Ikhwan Rinaldi |
| collection | DOAJ |
| description | Venous thromboembolism (VTE) is a serious complication that can occur during and after postoperative treatment, including in treatment after orthopedic surgery. The current guidelines for VTE prophylaxis in postoperative patients recommend the use of LMWHs, one of which is enoxaparin. Another recommendation for use in pharmacological VTE prophylaxis is rivaroxaban, which has better efficacy than enoxaparin but a higher bleeding risk. The aim of this systematic review is to provide an update on the profile of rivaroxaban for VTE prophylaxis after orthopedic surgery. PubMed, SCOPUS, EMBASE, and EBSCOhost were searched up until May 2022. The outcome sought was efficacy and safety, described by the incidence of VTE and incidence of bleeding, respectively. Five randomized controlled trials (RCT) were finally included. Rivaroxaban was confirmed to have better efficacy by significantly reducing the risk of VTE and all-cause mortality (RR = 0.38; 95% CI = 0.27–0.54) compared to enoxaparin. However, regarding the safety variable, no significant difference was found between the incidence of major bleeding in rivaroxaban and enoxaparin (RR = 0.97; 95% CI = 0.56–1.68). The results of the analysis show that rivaroxaban has better efficacy than enoxaparin but the same safety profile, so when used, the bleeding of patients should still be monitored. |
| first_indexed | 2024-03-09T03:18:51Z |
| format | Article |
| id | doaj.art-5f275cc772634ddc96e91b3dc97c3963 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T03:18:51Z |
| publishDate | 2022-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-5f275cc772634ddc96e91b3dc97c39632023-12-03T15:13:09ZengMDPI AGJournal of Clinical Medicine2077-03832022-07-011114407010.3390/jcm11144070Comparison of the Efficacy and Safety of Rivaroxaban and Enoxaparin as Thromboprophylaxis Agents for Orthopedic Surgery—Systematic Review and Meta-AnalysisIkhwan Rinaldi0Ihya Fakhrurizal Amin1Yuli Maulidiya Shufiyani2Idham Rafly Dewantara3Brenda Cristie Edina4Kevin Winston5Yusuf Aji Samudera Nurrobi6Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Cipto Mangunkusomo National General Hospital, Universitas Indonesia, Jakarta 10430, IndonesiaFaculty of Medicine, Universitas Indonesia, Jakarta 10430, IndonesiaFaculty of Medicine, Universitas Indonesia, Jakarta 10430, IndonesiaFaculty of Medicine, Universitas Indonesia, Jakarta 10430, IndonesiaFaculty of Medicine, Universitas Indonesia, Jakarta 10430, IndonesiaFaculty of Medicine, Universitas Indonesia, Jakarta 10430, IndonesiaPertamina Hospital, Balikpapan 76111, IndonesiaVenous thromboembolism (VTE) is a serious complication that can occur during and after postoperative treatment, including in treatment after orthopedic surgery. The current guidelines for VTE prophylaxis in postoperative patients recommend the use of LMWHs, one of which is enoxaparin. Another recommendation for use in pharmacological VTE prophylaxis is rivaroxaban, which has better efficacy than enoxaparin but a higher bleeding risk. The aim of this systematic review is to provide an update on the profile of rivaroxaban for VTE prophylaxis after orthopedic surgery. PubMed, SCOPUS, EMBASE, and EBSCOhost were searched up until May 2022. The outcome sought was efficacy and safety, described by the incidence of VTE and incidence of bleeding, respectively. Five randomized controlled trials (RCT) were finally included. Rivaroxaban was confirmed to have better efficacy by significantly reducing the risk of VTE and all-cause mortality (RR = 0.38; 95% CI = 0.27–0.54) compared to enoxaparin. However, regarding the safety variable, no significant difference was found between the incidence of major bleeding in rivaroxaban and enoxaparin (RR = 0.97; 95% CI = 0.56–1.68). The results of the analysis show that rivaroxaban has better efficacy than enoxaparin but the same safety profile, so when used, the bleeding of patients should still be monitored.https://www.mdpi.com/2077-0383/11/14/4070rivaroxabanenoxaparinorthopedic surgerythromboprophylaxisvenous thromboembolismmajor bleeding |
| spellingShingle | Ikhwan Rinaldi Ihya Fakhrurizal Amin Yuli Maulidiya Shufiyani Idham Rafly Dewantara Brenda Cristie Edina Kevin Winston Yusuf Aji Samudera Nurrobi Comparison of the Efficacy and Safety of Rivaroxaban and Enoxaparin as Thromboprophylaxis Agents for Orthopedic Surgery—Systematic Review and Meta-Analysis Journal of Clinical Medicine rivaroxaban enoxaparin orthopedic surgery thromboprophylaxis venous thromboembolism major bleeding |
| title | Comparison of the Efficacy and Safety of Rivaroxaban and Enoxaparin as Thromboprophylaxis Agents for Orthopedic Surgery—Systematic Review and Meta-Analysis |
| title_full | Comparison of the Efficacy and Safety of Rivaroxaban and Enoxaparin as Thromboprophylaxis Agents for Orthopedic Surgery—Systematic Review and Meta-Analysis |
| title_fullStr | Comparison of the Efficacy and Safety of Rivaroxaban and Enoxaparin as Thromboprophylaxis Agents for Orthopedic Surgery—Systematic Review and Meta-Analysis |
| title_full_unstemmed | Comparison of the Efficacy and Safety of Rivaroxaban and Enoxaparin as Thromboprophylaxis Agents for Orthopedic Surgery—Systematic Review and Meta-Analysis |
| title_short | Comparison of the Efficacy and Safety of Rivaroxaban and Enoxaparin as Thromboprophylaxis Agents for Orthopedic Surgery—Systematic Review and Meta-Analysis |
| title_sort | comparison of the efficacy and safety of rivaroxaban and enoxaparin as thromboprophylaxis agents for orthopedic surgery systematic review and meta analysis |
| topic | rivaroxaban enoxaparin orthopedic surgery thromboprophylaxis venous thromboembolism major bleeding |
| url | https://www.mdpi.com/2077-0383/11/14/4070 |
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