title: Comparison of Postoperative Bleeding in Total Hip and Knee Arthroplasty Patients Receiving Rivaroxaban or Enoxaparin.
abstract: BACKGROUND
  The Regulation of Coagulation in Orthopedic Surgery to Prevent Deep Venous Thrombosis and Pulmonary Embolism (RECORD) 1 to 4 trials compared rivaroxaban 10 mg daily with commonly used doses of enoxaparin and demonstrated similar rates of VTE and bleeding.
  
  
  OBJECTIVE
  To evaluate bleeding events between patients who received enoxaparin or rivaroxaban for prevention of venous thromboembolism (VTE) following total hip arthroplasty (THA) or total knee arthroplasty (TKA).
  
  
  METHODS
  Retrospective cohort that compared patients undergoing THA and TKA who received enoxaparin (enoxaparin) with those who received rivaroxaban (rivaroxaban) and also with those who received enoxaparin in the RECORD 1 to 4 trials (enoxaparin RECORD). The primary outcome was any postoperative bleeding, defined as a composite of major and clinically relevant nonmajor bleeding based on the definitions in the RECORD 1 to 4 trials.
  
  
  RESULTS
  There was a lower rate of any postoperative bleeding (2.2% vs 6.8%, P = 0.004) in patients who received enoxaparin compared with rivaroxaban, and bleeding rates between the enoxaparin group and the enoxaparin RECORD groups were similar (2.2% vs 2.5%, P = 0.085). Major bleeding in the enoxaparin group (0.2%) was not significantly different from that in the rivaroxaban group (1.4%, P = 0.12) or the RECORD group (0.2%, P = 0.93). Clinically relevant nonmajor bleeding was also lower in the enoxaparin group compared with the rivaroxaban group (2.0% vs 5.5%, P = 0.012).
  
  
  CONCLUSIONS
  The use of enoxaparin for VTE prophylaxis following THA and TKA was associated with a lower rate of the primary outcome (any postoperative bleeding) compared with the use of rivaroxaban in a similar cohort of patients.
authors.affiliation: Manchester University, Fort Wayne, IN, USA.
authors.forename: Abby L
authors.initials: AL
authors.lastname: Ricket
authors.affiliation: East Tennessee State University, Johnson City, TN, USA stewardw@etsu.edu.
authors.forename: David W
authors.initials: DW
authors.lastname: Stewart
authors.affiliation: East Tennessee State University, Johnson City, TN, USA James H. Quillen Veterans' Affairs Medical Center, Mountain Home, TN, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Wood
authors.affiliation: East Tennessee State University, Johnson City, TN, USA.
authors.forename: Lyndsey
authors.initials: L
authors.lastname: Cornett
authors.affiliation: East Tennessee State University, Johnson City, TN, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Odle
authors.affiliation: East Tennessee State University, Johnson City, TN, USA.
authors.forename: David
authors.initials: D
authors.lastname: Cluck
authors.affiliation: East Tennessee State University, Johnson City, TN, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Freshour
authors.affiliation: East Tennessee State University, Johnson City, TN, USA.
authors.forename: Hadi
authors.initials: H
authors.lastname: El-Bazouni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D017984:Enoxaparin / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000139:chemically induced; D011655:Pulmonary Embolism / Q000517:prevention & control; D012189:Retrospective Studies; D000069552:Rivaroxaban / Q000008:administration & dosage / Q000009:adverse effects*; D054556:Venous Thromboembolism / Q000517:prevention & control; D020246:Venous Thrombosis / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D000069552:Rivaroxaban
keywords: deep vein thrombosis; enoxaparin; pulmonary embolism; rivaroxaban; total hip arthroplasty; total knee arthroplasty; venous thromboembolism