Systematic review of prophylaxis for venous thromboembolism after knee arthroplasty: enoxaparin versus rivaroxaban.

ABSTRACT Total knee arthroplasty is an elective procedure performed on relatively healthy individuals. However, due to the inherent risk of venous thromboembolism, drugs are used for its prophylaxis. The objective of the present study was to conduct a systematic review of the literature to compare the efficacy of enoxaparin and rivaroxaban in preventing this complication and the risk of intraoperative bleeding. We reviewed the SciELO, Pubmed and Cochrane databases with the descriptors knee arthroplasty, rivaroxaban and enoxaparin through the PICO search strategy. Inclusion criteria were the articles during the study period comparing both drugs in knee arthroplasty. Relevant criteria to study eligibility were articles published since 2010 and with a sample of more than 20 patients; studies obtained in their entirety; and studies with follow-up of more than 12 months. The variables used to compare the articles were the most common postoperative complications of knee arthroplasties: venous thromboembolism and bleeding. We used the Review Man software, version 5.3, for structuring the review. In the studies analyzed, considering symptomatic venous thromboembolism, rivaroxaban resulted in higher benefits when compared to enoxaparin.摘要：全膝关节置换术（Total Knee Arthroplasty）是针对相对健康人群开展的择期手术。由于静脉血栓栓塞症（Venous Thromboembolism）存在固有发病风险，临床需通过药物实施预防。本研究旨在开展系统文献综述，对比依诺肝素（enoxaparin）与利伐沙班（rivaroxaban）在预防该并发症的疗效及术中出血风险方面的差异。本研究采用PICO检索策略，以“膝关节置换术、利伐沙班、依诺肝素”为检索词，检索了SciELO、PubMed及Cochrane数据库。纳入标准包括：研究期间内对比两种药物用于膝关节置换术的相关文献；2010年以来发表、样本量超过20例患者的完整研究；随访时长超过12个月的研究。本研究选取的比较变量为膝关节置换术后最常见的两类并发症：静脉血栓栓塞症与出血事件。本研究使用RevMan 5.3版（Review Manager 5.3）完成综述的结构化构建。在所分析的研究中，针对症状性静脉血栓栓塞症，利伐沙班相较依诺肝素展现出更显著的获益效果。