IS XARELTO SUPERIOR TO ASPIRIN FOR POSTOPERATIVE VTE PROPHYLAXIS AFTER ORTHOPEDIC SURGERY?

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: One of the biggest complications that arise from a Major Joint Surgery (MJS): Total Knee Arthroplasty (TKA), Total Hip Arthroplasty (THA), and Hip Fracture Surgery (HFS) are Venous Thrombo-Embolism (VTE) disorder. VTE encompasses both Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE), a major cause of mortality and morbidity in these patients. Without proper prophylaxis after MJS, patients are at high risk for DVT with an incidence of 40%-85% and PE 1-2%. Conventional drug therapies that are used as prophylaxis currently are includes Enoxaparin, Coumadin and Xarelto. However, the American Academy of Orthopedic Surgeons and American College of Chest Physicians have no consensus regarding the best drug for prophylaxis. METHODS: A systematic review was conducted through PubMed to identify relevant studies from January 2014- December 2019 with comparative data on aspirin versus rivaroxaban for VTE prophylaxis after MJS. The primary outcomes that were analyzed were DVT, PE, and any VTE rates. Secondary outcomes included were major bleeding events (bleeding into joint space), other bleeding events, wound complications, and readmissions. Results are expressed as Standard Difference in means with Standard Error (SD+SE). Statistical analysis was done using Random-Effects Meta-Analysis to compare the mean value of the two groups (Comprehensive Meta Analysis Version 3.3.070 software; Biostat Inc., Englewood, NJ). RESULTS: Ten out of the 3530 studies were quantitatively assessed and included for meta-analysis. TKA was performed in 528,549 patients, THA in 242,756 patients and HFS in 329 patients. Aspirin was administered in 34,330 patients and Xarelto in 90,482 patients. The incidence of VTEs (0.314 ± 0.087; p=0.000) and DVTs (0.231 ± 0.074; p=0.002) were higher in the Aspirin group when compared to Xarelto use.PE (0.155 ± 0.19; p=0.414), Major bleeding events (-0.015 ± 0.365; p=0.967) , Overall bleeding events (-0.148 ± 0.080; p=0.064), Wound complications (-0.312 ± 0.326; p=0.339) and Readmissions (0.132 ± 0.147; p=0.369) were similar in both groups. CONCLUSIONS: Xarelto is superior to Aspirin for post operative prophylaxis of Venous Thromboembolism after Major Orthopedic Surgical procedures. CLINICAL IMPLICATIONS: The controversial drug Aspirin which is cost-effective with less bleeding compared to the conventional medications has been reported in many studies to be effective at preventing VTE. This study aims to compare post-operative surgical and thromboembolic complications following the use of Aspirin or Xarelto as VTE prophylaxis after MJS. DISCLOSURES: No relevant relationships by Ardica Kamaalananthan, source=Web Response No relevant relationships by Aliu Sanni, source=Web Response