A Pilot Study Comparing Hospital Readmission Rates In Patients Receiving Rivaroxaban or Enoxaparin After Orthopedic Surgery.

PURPOSE A pilot study was conducted to determine whether rivaroxaban (Xarelto, Janssen Pharmaceuticals) resulted in a lower 30-day all-cause readmission rate compared with enoxaparin (Lovenox, Sanofi-Aventis) after total hip arthroplasty (THA) or total knee arthroplasty (TKA) at a community hospital. METHODS The study was a single-center, retrospective, chart-review investigation involving patients who underwent THA or TKA between May 2013 and May 2014. The study's primary endpoint was the 30-day all-cause readmission rate. The 30-day readmission rate due to venous thromboembolism (VTE) or any bleeding event was a secondary endpoint. Patients who received oral rivaroxaban (10 mg once daily) or subcutaneous enoxaparin (30 mg twice daily or 40 mg once daily) were included in the study. Patients were excluded if they had a history of heparin-induced thrombocytopenia; a history of allergy associated with heparin or rivaroxaban; a hypercoagulation disorder; or creatinine clearance of less than 30 mL/min. Patients were also excluded if they had received an anticoagulant before admission, were discharged more than 30 days after admission, or died before discharge. RESULTS A total of 543 patients underwent THA or TKA between May 2013 and May 2014. We reviewed 405 patient charts, and 240 patients met the inclusion criteria. Most of the excluded patients had received only aspirin for VTE prophylaxis. The primary outcome was reached in eight of 213 patients in the rivaroxaban group (3.76%) and in one of 27 patients in the enoxaparin group (3.70%) (P = 1). The secondary outcome was reached in two patients (0.9%) in the rivaroxaban group. CONCLUSION Rivaroxaban did not significantly reduce the 30-day all-cause readmission rate compared with enoxaparin in patients who had undergone THA or TKA. Further research in a larger, multicenter study is needed to confirm these results.