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Scientific Articles   |    
Wound Complications Following Rivaroxaban AdministrationA Multicenter Comparison with Low-Molecular-Weight Heparins for Thromboprophylaxis in Lower Limb Arthroplasty
Simon S. Jameson, MRCS1; Monika Rymaszewska, MRCS1; Philip James2; Ignacio Serrano-Pedraza, PhD3; Scott D. Muller, MD, FRCS(Tr&Orth)4; Anthony C.W. Hui, MA, FRCSEd(Orth)1; Mike R. Reed, MD, FRCS(Tr&Orth)4
1 Trauma & Orthopaedics, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, United Kingdom. E-mail address for S.S. Jameson: simonjameson@doctors.org.uk
2 CHKS Healthcare Intelligence Services, 1 Arden Court, Arden Road, Alcester, Warwickshire, B49 6HN, United Kingdom
3 University of Newcastle on Tyne, Claremont Road, Newcastle on Tyne, NE1 7RU, United Kingdom
4 Northumbria Healthcare NHS Foundation Trust, NE63 9JJ, Woodhorn Lane, Ashington, United Kingdom
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  • Disclosure statement for author(s): PDF

Investigation performed at the National Orthopaedic Research and Surgical Outcomes Collaboration, Ashington, United Kingdom

This article was chosen to appear electronically on July 25, 2012, in advance of publication in a regularly scheduled issue.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Sep 05;94(17):1554-1558. doi: 10.2106/JBJS.K.00521
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Abstract

Background: 

The oral anticoagulant rivaroxaban is recommended for venous thromboembolic prophylaxis following lower limb arthroplasty. Concerns regarding high rates of wound complications following its use have prompted this multicenter comparison with low-molecular-weight heparins.

Methods: 

English hospital trusts that replaced a low-molecular-weight heparin with rivaroxaban for thromboprophylaxis in lower limb arthroplasty during 2009 were identified. Prospectively collected national data for these units were analyzed to determine the thirty-day rates of wound complications and major bleeding (cerebrovascular event or gastrointestinal hemorrhage) and the ninety-day rates of symptomatic deep venous thrombosis (proximal or distal), symptomatic pulmonary embolism, and all-cause inpatient mortality before and after the change to rivaroxaban. A total of 2762 patients prescribed rivaroxaban following knee or hip arthroplasty were compared with 10,361 patients prescribed a low-molecular-weight heparin. Data were analyzed with use of odds ratios (ORs).

Results: 

There were significantly fewer wound complications in the low-molecular-weight heparin group (2.81% compared with 3.85%; OR = 0.72, 95% confidence interval [CI] = 0.58 to 0.90; p = 0.005). There were no significant differences between the low-molecular-weight heparin and rivaroxaban groups in the rates of pulmonary embolism (0.55% compared with 0.36%; OR = 1.52, 95% CI = 0.78 to 2.98), major bleeding (OR = 0.73, 95% CI = 0.48 to 1.12), or all-cause mortality (OR = 0.93, 95% CI = 0.46 to 1.89). There were significantly more symptomatic deep venous thromboses in the low-molecular-weight heparin group (0.91% compared with 0.36%; OR = 2.51, 95% CI = 1.31 to 4.84; p = 0.004).

Conclusions: 

The rivaroxaban group had a higher wound complication rate and a lower deep venous thrombosis rate; there were no differences in symptomatic pulmonary embolism or all-cause mortality. Longer follow-up is needed to assess any potential relationship between wound complications and joint stiffness, latent infection, and limb consequences of deep venous thrombosis.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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