VTE Prevention Following Total Hip and Knee Arthroplasty
- Conditions
- Venous Thromboembolism
- Interventions
- Drug: acetylsalicylic acid 81 mg
- Registration Number
- NCT04075240
- Lead Sponsor
- Sudeep Shivakumar
- Brief Summary
Consented patients undergoing elective total hip and total knee arthroplasty will be randomized to receive either aspirin alone or aspirin and rivaroxaban for prevention of venous thromboembolism.
- Detailed Description
Aspirin and rivaroxaban prevent venous thromboembolism (VTE) via different mechanisms. Aspirin is significantly cheaper than rivaroxaban. Aspirin in combination with rivaroxaban was shown to be safe and efficacious in a non-inferiority trial (EPCATII) when compared to rivaroxaban alone.
This study will assess if aspirin alone is non-inferior to rivaroxaban and aspirin in the prevention of venous thromboembolism.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 5400
- Patients undergoing elective THA/TKA at the participating institutions will be potentially eligible for this study
- Written informed consent in accordance with federal, local and institutional guidelines
- Previous documented VTE (proximal DVT or any PE)
- Hip or lower limb fracture in the previous three months, not related to present surgery
- Metastatic cancer
- Life expectancy less than 6 months
- History of major bleeding that in the judgment of the investigator precludes use of anticoagulant prophylaxis
- History of aspirin allergy, active peptic ulcer disease or gastritis that in the judgment of investigator precludes use of aspirin
- History of significant hepatic disease or any other condition that in the judgment of the investigator precludes the use of rivaroxaban
- Creatinine clearance less than 15 ml per minute
- Pre-operative platelet count less than 100 x 109 /L
- Need for long-term anticoagulation due to a pre-existing co-morbid condition or due to the development of VTE following surgery but prior to randomization
- Received anticoagulation post operatively
- Bilateral THA/TKA or simultaneous hip and knee arthroplasty
- Major surgical procedure within the previous 3 months
- Requirement for major surgery post arthroplasty within a 90 day period
- Chronic daily aspirin use with dose greater than 100 mg a day
- Women of childbearing potential who are not abstinent or do not use effective contraception or are breast-feeding throughout the study drug period
- Unwilling or unable to give consent
- Previous participation in the EPCAT III study
- Under 18 years of age
- Concomitant use of drugs that are strong inhibitors of P-gp AND CYP3A4 (e.g., systemic treatment with ketoconazole, itraconazole, or ritonavir) or strong inducers of P-gp AND CYP3A4 (e.g., rifampicin, phenytoin, carbamazepine, phenobarbital, St. John's Wort)
- Known allergy to food dye
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SEQUENTIAL
- Arm && Interventions
Group Intervention Description THA-control arm Rivaroxaban 10 MG and acetylsalicylic acid 81 mg Total Hip Arthroplasty: 5 days of rivaroxaban, followed by 30 days of aspirin THA-study arm acetylsalicylic acid 81 mg Total Hip Arthroplasty: 35 days of aspirin TKA-study arm acetylsalicylic acid 81 mg Total Knee Arthroplasty: 14 days of aspirin TKA-control arm Rivaroxaban 10 MG and acetylsalicylic acid 81 mg Total Knee Arthroplasty: 5 days of rivaroxaban, followed by 9 days of aspirin
- Primary Outcome Measures
Name Time Method Venous thromboembolism 90 days symptomatic proximal deep vein thrombosis or pulmonary embolism
Bleeding 90 days major and clinically relevant, non-major bleeds
- Secondary Outcome Measures
Name Time Method Survival 90 days all cause death
Cost-effectiveness 90 days quantitatively describe the costs of symptomatic thromboembolism events and major bleeding episodes
Trial Locations
- Locations (1)
Queen Elizabeth II HSC
🇨🇦Halifax, Nova Scotia, Canada