Rivaroxaban may be the most effective strategy for preventing deep vein thrombosis (DVT) among patients undergoing total knee replacement, according to research published in The Lancet Haematology.1

Previously published work has suggested that hospital-acquired thromboembolism — DVT or pulmonary embolism occurring during hospitalization or within 90 days of discharge — is a common and serious health issue that poses both dangers to the patient and high costs to health care systems. Furthermore, patients undergoing elective total knee replacement have a more than 50% risk for venous thromboembolism.

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For this study, researchers conducted a systematic review and Bayesian network meta-analyses of randomized control trials investigating prophylactic strategies against venous thromboembolism, with the aim of assessing the relative efficacy and safety of each.

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Of nearly 9000 retrieved articles, 25 studies were included in the network meta-analyses. Twenty-three trials representing 19 interventions were included in the DVT network, 12 trials representing 13 interventions were included in the pulmonary embolism network, and 19 trials representing 11 interventions were included in the major bleeding network.

In the DVT network, rivaroxaban alone was the best-ranked drug for prevention (relative risk, 0.12), while the standard prophylactic dose of low-molecular-weight heparin was the highest ranked drug in both the pulmonary embolism network (relative risk, 0.02) and the major bleeding network (odds ratio, 0.08). Single-drug strategies appeared generally more effective for preventing DVT compared with combined strategies.

The authors noted, however, that the results for the pulmonary embolism and major bleeding network analyses were highly uncertain.

They concluded that these “results provide a consistent set of relative treatment effects and their associated uncertainty, which could be used in economic models to assess the cost-effectiveness of these strategies in any jurisdiction.”


1.     Lewis S, Glen J, Dawoud D, et al. Venous thromboembolism prophylaxis strategies for people undergoing elective total knee replacement: a systematic review and network meta-analysis [published online August 20, 2019]. Lancet Haematol. doi:10.1016/S2352-3026(19)30155-3