Apixaban and Rivaroxaban Decrease Deep Venous Thrombosis But Not Other Complications After Total Hip and Total Knee Arthroplasty

Apixaban and rivaroxaban are oral direct factor Xa (FXa) inhibitors used for VTE prevention after total hip (THA) and total knee arthroplasty (TKA). A meta-analysis of level I studies comparing rivaroxaban 10 mg daily or apixaban 2.5 mg twice daily to enoxaparin for the prevention of VTE after THA or TKA was performed analyzing efficacy and safety outcomes. Seven studies met the inclusion criteria including 24,385 patients. Oral FXa inhibitors were superior to enoxaparin in preventing DVT (p < 0.00001). There was no difference in the rate of PE, death, major bleeding, blood transfusion requirement, reoperation for bleeding or postoperative wound infections. Oral FXa inhibitors are superior to enoxaparin in preventing DVT after THA and TKA. There is no difference in the rate of PE, death, or postoperative wound complications.