A meta-analysis on the efficacy and safety of rivaroxaban versus low molecular weight heparin calcium in the prevention of venous thromboembolism after hip and knee replacement

LI Jian; QIU Bing; ZHEN Dong; GUO Yong-ming

doi:10.3969/j.issn.2095-252X.2018.04.008

Abstract：Objective To compare the efficacy and safety of rivaroxaban versus low molecular weight heparin calcium in the prevention of venous thromboembolism (VTE) after hip and knee replacement. Methods PubMed, EMbase, EBSCO, CBM, CNKI, and Wanfang databases (from database establishment to September, 2017) were searched for randomized controlled trials (RCTs) comparing efficacy and safety of rivaroxaban versus low molecular weight heparin calcium in the prevention of venous thromboembolism (VTE) after hip and knee replacement. The incidence of total deep venous thrombosis (DVT), total VTE, symptomatic VTE, pulmonary embolism (PE), severe bleeding and any other adverse events were compared. And the results were presented with odds ratio (OR) with 95％ confidence interval (CI). RevMan5.3 was used for a meta analysis. Results Totally 11 RCTs of 3624 cases were included in this study. 1581 cases accepted rivaroxaban (treatment group), while 2043 cases accepted low molecular weight heparin calcium (control group). The results of Meta-analysis were as follows: The incidences of total DVE, total VTE, severe bleeding were significantly lower in rivaroxaban group than in low molecular weight heparin calcium group [OR =0.48, 95％ CI = (0.35, 0.66), P ＜ 0.00001; OR =0.58, 95％ CI = (0.39, 0.87), P =0.008; OR =0.39, 95％ CI = (0.26, 0.59), P ＜ 0.00001]; There were no significant differences between the 2 groups in the incidence of symptomatic VTE, pulmonary embolism (PE), severe bleeding and any other adverse events [OR =0.59, 95％ CI = (0.22, 1.63), P =0.31; OR =0.89, 95％ CI = (0.40, 1.96), P =0.77]. Conclusions In the thromboprophylaxis after hip and knee replacement, efficacy and safety of rivaroxaban are better than that of low molecular weight heparin calcium. Meanwhile, rivaroxaban will not increase the risk of adverse events, and can significantly reduce the risk of postoperative deep vein thrombosis.