By Amy Orciari Herman
Edited by André Sofair, MD, MPH
Rivaroxaban monotherapy is the most effective strategy for preventing deep-venous thrombosis (DVT) after elective total knee replacement, a meta-analysis in the Lancet Haematology suggests.
The analysis included 25 randomized controlled trials of venous thromboembolism prophylaxis strategies in patients aged 16 and older undergoing elective knee replacement. Strategies included medications, mechanical interventions, and combinations of the two.
Overall, single treatments were the most effective for preventing DVT. Compared with no prophylaxis, rivaroxaban conferred the greatest risk reduction (relative risk, 0.12), followed by apixaban (RR, 0.15), high-dose LMWH (RR, 0.18), and foot pumps (RR, 0.20). LMWH alone was more effective than LMWH with compression stockings — “[calling] into question the value of combined prophylaxis in this population,” the researchers note.
In terms of pulmonary embolism and major bleeding outcomes, the researchers say the results “were highly uncertain because of the sparse nature of the networks and the small number of randomised controlled trials per comparison, so no firm conclusions can be made.”