Efficacy of Rivaroxaban in Prophylaxis against Venous Thromboembolism after Total Knee Arthroplasty

Author(s): Sivaprasad Kalyanasundaram1 , Khalid Fiyaz Mohammed2 , Raghavendra S.3 , Sangamesh Vijaykumar Hawaldar4 , Shiva Shankaran Balaji G.B.5

BACKGROUND Venous thromboembolism is a potentially fatal complication after major orthopaedic surgeries like total knee arthroplasty, and total hip arthroplasty. Venous thromboembolism comprises of deep vein thrombosis, pulmonary embolism. It is a preventable complication of in-hospital mortality. The prophylaxis to prevent VTE varies from warfarin, low molecular weight heparin like enoxaparin, Fondaparinux sodium, direct factor Xa inhibitor like rivaroxaban and apixaban, and mechanical thromboprophylaxis. METHODS We studied the efficacy of oral rivaroxaban 10 mg once daily for 14 days in the prevention of VTE in 60 elective cases of total knee arthroplasty. The study was done from August 2018 to December 2019. All the operated cases were cemented with cruciate retaining prosthesis with mean operative time of 120 minutes without any intra-op events. Oral Rivaroxaban 10 mg was given after 6-8 hours after wound closure and continued for 14 days. All the patients were closely monitored for signs and symptoms of DVT, PE with Wells DVT score followed by venous angiogram and signs of pulmonary embolism were evaluated with modified Gurd and Wilson criteria and subsequent CT pulmonary angiogram. RESULTS One patient developed deep venous thromboembolism (1.6%). No bleeding manifestations or pulmonary embolism were reported. In the study, majority of the subjects were in the age group of <60 years (46.7%); 70% were females and 30% were males; 48.3% were overweight; 33.3% were obese grade I and 3.3% were obese grade II. CONCLUSIONS Once daily oral dose of rivaroxaban 10 mg for 14 days is an effective modality in reducing the number of cases of VTE after Total knee arthroplasty. Our study highlights the potential benefits and risk associated with the use of rivaroxaban as the drug of choice for thromboprophylaxis. The ease of administration of oral agents compared to subcutaneously given agents like Enoxaparin will lead to better patient compliance and early discharge from hospital.