Level 1: Likely reliable evidence
Oral rivaroxaban is more effective than subcutaneous enoxaparin for reducing risk of symptomatic deep venous thrombosis (DVT) after total knee arthroplasty, based on a study involving 2,531 patients older than 18 years who were scheduled for elective total knee arthroplasty (N Engl J Med. 2008;358:2776-2786). Patients were randomized to oral rivaroxaban 10 mg once daily vs. subcutaneous enoxaparin 40 mg once daily for 10-14 days. Rivaroxaban was started six to eight hours postoperatively; a single dose of enoxaparin was given 12 hours before surgery, with daily dosing beginning six to eight hours postoperatively. All patients also received either oral or subcutaneous placebo. A total of 113 patients did not complete the study. Among the 2,418 patients who received a study drug and had surgery, symptomatic DVT occurred in 0.7% of the rivaroxaban group vs. 2% of the enoxaparin group (P = .005, NNT 77). There were no significant differences in adverse events.