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Many protocols call for anticoagulation after total hip or total knee arthroplasty to prevent venous thromboembolism (proximal deep-vein thrombosis or pulmonary embolism), and some reports have suggested a role for aspiring or direct oral anticoagulants as preventative therapy.
Patients undergoing total hip or knee arthroplasty were given oral rivaroxaban (Xarelto) 10 mg until postoperative day 5 and then were randomly assigned to continue rivaroxaban (RIX) or switch to aspirin (81 mg daily) for an additional 9 days after total knee arthroplasty (TKA) or for 30 days after total hip arthroplasty (THA). The primary outcome was venous thromboembolism by 90 days.
They enrolled 3424 patients (1804 THA and 1620 TKA) were enrolled in the trial. There was no difference in the frequency of venous thromboembolism in the ASA patients (0.64%) and RIX patients (0.70%).
There was no significant difference in major bleeding complications with ASA (0.47%) or RIX (0.29%) post-operatively.
These results suggest that extended prophylaxis with either ASA or RIX was equally effective after an initial 5 days course of RIX following THA or TKA, thereby demonstrating effective prevention of venous thromboembolism with oral direct anticoagulation.