title: The use of rivaroxaban for chemical thromboprophylaxis following total knee replacement.
abstract: BACKGROUND
  Pulmonary embolism is a leading cause of fatality in elective orthopaedics. Recently introduced oral thromboprophylaxis (rivaroxaban) has a logistic advantage but has also raised early concerns amongst arthroplasty surgeons
  
  
  OBJECTIVE
  The aim of this study was to evaluate the impact of rivaroxaban as a chemical thromboprophylaxis following knee arthroplasty in reference to radiologically diagnosed PE and return to theatre following wound complication.
  
  
  METHODS
  Following the introduction of new NICE guidelines in our institute 266 consecutive TKR receiving rivaroxaban were studied prospectively and compared with retrospectively collected consecutive 596 TKR prior to adoption of the guidelines. Both of these groups were studied for radiologically diagnosed symptomatic VTE episodes within 90days and return to theatre following wound complication.
  
  
  RESULTS
  A total of 862 cases were studied, out of which 596 were in the retrospective control group and 266 were in the prospective rivaroxaban group. Both the groups had a female predominance with a mean age at the time of surgery as 68 and 69 in control and prospective cohort respectively. There were 24 radiologically diagnosed symptomatic PE and one DVT in the control group whereas, the rivaroxaban prospective group had 2 PE and 2 DVT cases. The return to theatre following wound complication was 2 and 7 in control and prospective group respectively.
  
  
  CONCLUSIONS
  Following the introduction of rivaroxaban the number of symptomatic radiologically confirmed PE events declined (p=0.0084) but the return to theatre rate due to wound complications increased (p=0.0049).
  
  
  METHODS
  III.
authors.affiliation: The Department of Trauma and Orthopaedics, University Hospital of Wales, Cardiff, United Kingdom. Electronic address: rath.narendra@gmail.com.
authors.forename: N K
authors.initials: NK
authors.lastname: Rath
authors.forename: M W
authors.initials: MW
authors.lastname: Goodson
authors.forename: S P
authors.initials: SP
authors.lastname: White
authors.forename: M C
authors.initials: MC
authors.lastname: Forster
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000188:drug therapy / Q000517:prevention & control; D011322:Primary Prevention / Q000379:methods; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D000069552:Rivaroxaban; D015996:Survival Rate; D013876:Thiophenes / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D009025:Morpholines; D013876:Thiophenes; D000069552:Rivaroxaban
keywords: Pulmonary embolism; Rivaroxaban; Thromboprophylaxis; Total knee replacement; Wound complication