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Rivaroxaban efficacious after orthopedic surgery
Oral rivaroxaban treatment was more effective than enoxaparin for thromboprophylaxis after total hip arthroplasty and total knee arthroplasty, according to data presented at the 49th American Society of Hematology Annual Meeting and Exposition.
Bengt Eriksson, MD, an orthopedic surgeon at Sahlgrenska University Hospital/Östra in Gothenburg, Sweden, and colleagues compared oral rivaroxaban (Xarelto, Bayer) with enoxaparin (Lovenox, Sanofi Aventis) for thromboprophylaxis after total hip arthroplasty for the RECORD1 trial.
For the RECORD2 trial, Ajay Kakkar, MD, and colleagues at Barts and the London School of Medicine compared extended thromboprophylaxis with rivaroxaban after enoxaparin treatment with enoxaparin treatment alone.
The RECORD3 trial was conducted by Michael Rud Lassen, MD, and colleagues at the Spine Clinic, Clinical Trial Unit, Nordsjællands Hospital, Hørsholm in Copenhagen University Medical School, Denmark. They compared rivaroxaban with enoxaparin for thromboprophylaxis after total knee arthroplasty.
Benefits of rivaroxaban
According to Kenneth A. Bauer, MD, a professor of medicine at Harvard Medical School and a member of the Hemostasis & Coagulation Editorial Board for HemOnc Today, the first indication for a new anticoagulant is usually thromboprophylaxis after orthopedic surgery.
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“In addition to superior efficacy to enoxaparin, another potential advantage of oral rivaroxaban will likely be improved adherence to guidelines regarding duration of therapy after hip replacement surgery,” Bauer said. “Maintaining a daily injection schedule of low–molecular-weight heparin after discharge from the hospital is difficult for many patients.”
For RECORD1, patients were randomly assigned to rivaroxaban or enoxaparin. In the modified intent-to-treat population of 3,153 patients, the incidence of deep venous thrombosis, nonfatal pulmonary embolism and all-cause mortality was 1.1% in the rivaroxaban group vs. 3.7%.
Patients enrolled in the RECORD2 trial were randomly assigned to enoxaparin with placebo or rivaroxaban after total hip arthroplasty. In the modified intent-to-treat population of 1,733 patients, the incidence of DVT, nonfatal pulmonary embolism and all-cause mortality was 9.3% in the placebo group vs. 2% in the rivaroxaban group.
After total knee arthroplasty, patients enrolled in the RECORD3 trial were randomly assigned to rivaroxaban or enoxaparin. The modified intent-to-treat population included 1,702 patients. The incidence of DVT, nonfatal pulmonary embolism and all-cause mortality was 18.9% in the enoxaparin group vs. 9.6% in the rivaroxaban group. – by Emily Shafer
For more information:
- Eriksson B, Borris L, Friedman R, et al. #6
- Kakkar A, Brenner B, Dahl O, et al. #307
- Lassen M, Turpie A, Rosencher N, et al. #308.
All presented at: American Society of Hematology 49th Annual Meeting and Exposition. Dec. 8-11, 2007. Atlanta.