Rivaroxaban Lowers Risk of Venous Thromboembolism for Orthopedic Surgeries as Compared to Heparin


According to a news release from the American College of Cardiology, rivaroxaban is more effective than enoxaprin (heparin) in preventing blood clots or low platelet counts in patients after orthopedic surgery. Research found that rivaroxaban cut down on the risk of serious venous thromboembolism.

In other scenarios, heparin has been linked to thrombocytopenia, giving rivaroxaban the leg up for patient treatment.

About Venous Thromboembolism

Venous thromboembolism (VTE) is a blood disorder which occurs when blood clots form in a vein. The veins impacted carry blood to the heart. VTE can encompass:

  • Deep vein thrombosis (DVT), in which a blood clot forms in a deep vein. These most often occur in the lower body, in the pelvis, thighs, or lower legs.
  • Pulmonary embolism (PE), in which the blood clot breaks loose from the vein and travels to the lungs. This can be fatal, as the clots can block arteries in the lung and restrict the flow of oxygen.
Venous thromboembolism
Source: Wikimedia, ZYjacklin / Public domain


Patients are most at risk of developing venous thromboembolism after bodily injury or surgery. However, cancer, a heart attack, or other conditions can also stimulate the development of VTE. While some patients may not show symptoms, those who do may experience sudden chest pain, swelling, and shortness of breath. Learn more here.

Research Findings

Rivaroxaban is an orally administered anticoagulant, which many may know as XARELTA. Researchers sought to understand how it compared to enoxaparin, a low molecular weight heparin, in reducing the development of blood clot for patients recovering from orthopedic surgeries. The patients being examined did not have major surgeries. However, to facilitate healing, they were required to restrict the movement of their lower limbs impacted by surgery.

The study followed 3,604 patients from 10 countries who needed to restrict their movement for 15 days or more. Patients were split into two groups. The first group took 10mg of rivaroxaban once daily, while the others took 40 ml of enoxaparin once daily, administered via injection. As it was a double-blind study, all 3,604 patients received both a shot and a pill, but nobody was aware of which was the placebo.

4 patients, who received rivaroxaban, experienced primary complications due to venous thromboembolism. In the group that received enoxaparin, 18 patients experienced complications. Secondary outcomes included bleeding or thrombocytopenia, or low blood platelet count.

About Thrombocytopenia

Thrombocytopenia is a condition in which there are low levels of platelets (blood cells), and a patient may have difficulty forming blood clots or stopping bleeding. Patients with platelet counts under 150,000 have thrombocytopenia. Symptoms include excessive and prolonged bleeding, blood in the urine, fatigue, and an enlarged spleen. Learn more about thrombocytopenia on our site.

As stated before, thrombocytopenia can be caused by medication. For example, Heparin lowers platelet levels. Despite a patient having thrombocytopenia, Heparin-induced thrombocytopenia causes platelets to clot together, raising the risk of venous thromboembolism. While this is most common in patients taking regular heparin, it can also occur in low molecule weight heparin, such as enoxaprin.

Rivaroxaban Impact on Venous Thromboembolism

Rivaroxaban blocks Xa, a clotting protein factor. As a strong anticoagulant, researchers were initially worried that the drug might present more of a bleeding risk than enoxaparin. But they were pleasantly surprised. According to researchers, rivoraxaban decreased the risk of VTE for orthopedic patients by 75%. However, it did not increase the risk of bleeding, making it a potentially safer option for patients who are taking blood thinners.

In comparison, researchers found that many of the patients who had taken low molecular weight heparin had proximal asymptomatic deep vein thrombosis. As such, they were at a higher risk of developing a pulmonary embolism.

Unlike enoxaparin, which requires subcutaneous (below the skin) injections, rivoraxaban can be taken orally. It presents an easier option for patients. Additionally, it keeps them from needing to disrupt their lives to visit the doctor for injection assistance.

As millions of people worldwide undergo orthopedic surgeries each year, such as ankle surgery or ligament repair, it is important to have a medication that can prevent VTEs. However, most of these were previously focused on patients with major surgeries.

Jessica Lynn

Jessica Lynn

Jessica Lynn has an educational background in writing and marketing. She firmly believes in the power of writing in amplifying voices, and looks forward to doing so for the rare disease community.

Share this post