Aspirin Or Rivaroxaban For Venous Thromboembolism Prophylaxis After Total Hip Arthroplasty:a Randomized Controlled Trial

Background:Venous thromboembolism(VTE),including deep venous thrombosis(DVT),is a common complication after total hip arthroplasty(THA).Rivaroxaban plays an effective role in preventing DVT,but it also poses the patients under relatively high risk of bleeding.Recently,aspirin has been considered to have good antithrombotic efficacy and safety in clinical practice.There is great need to explore aspirin’s effectiveness and its appropriate dose for D VT prevention after THA surgery.Objective:Our study aims to investigate the antithrombotic efficacy and safety of aspirin versus rivaroxaban after THA.Materials and Methods:This randomized controlled trial enrolled patients who underwent unilateral or bilateral THA surgery and were then randomly divided into aspirin group and rivaroxaban group,in which patients continued oral aspirin(100 mg/times,twice daily)and rivaroxaban(10 mg/times,once daily)respectively from the first to the 35th day after surgery.A routine hematological test was performed at the 1st,3rd,5th,and 30th days after the operation,and a deep vein ultrasound examination was performed before and at the 35th day after the operation.Basic demographic information,joint function,rate of DVT,bleeding and other complications were recorded.The differences between the two groups were analyzed by statistical tests.Results:A total of 102 patients were included in the study,including 70 patients receiving unilateral THA(uni-THA,34 in aspirin group and 36 patients in rivaroxaban group)and 32 patients with bilateral THA(bi-THA,13 in aspirin group and 19 patients in rivaroxaban group).There were no significant differences in postoperative Harris hip score(uni-THA with aspirin:8%,uni-THA with rivaroxaban:7.7%;bi-THA with aspirin:12.5%,bi-THA with rivaroxaban:10%),incidence of bleeding events(aspirin:7.3%,rivaroxaban:4.3%)or the incidence of total complications(aspirin:19.2%,rivaroxaban:16.4%)when comparing two groups after unilateral or bilateral THA.With non-inferiority test,the DVT rate in aspirin group was non-inferior to that in rivaroxaban group.In patients receiving unilateral THA,the total postoperative blood loss volume in the aspirin group(864.32±346.50)was significantly lower than that in the rivaroxaban group(1243.79±839.82)(p=0.02),while there was no difference in bilateral THA patients.Conclusion:Aspirin is similarly effective to rivaroxaban in the prevention of postoperative DVT after THA.In patients receiving unilateral THA,aspirin use may reduce total blood loss volume.There was no significant difference in the incidence of postoperative complications under either medication.Aspirin could be regarded as an effective and safe antithrombotic drug after THA.