Eight RCTs were included in the review (n=15,586 patients). The trial sample size ranged from 621 to 4,541 patients. Most trials were double blind, but open-label trials were also included. The trial quality was generally good: five trials scored 5 two trials scored 4 nd one trial scored 3.
Efficacy: Rivaroxaban thromboprophylaxis was associated with a statistically significant lower total venous thromboembolism and all cause mortality (RR 0.56, 95% CI 0.39 to 0.80; I2=82%), major VTE (RR 0.42, 95% CI 0.20 to 0.84; I2=71%), deep vein thrombosis (RR 0.54, 95% CI 0.37 to 0.79; I2=82%), and symptomatic venous thromboembolism (RR 0.49, 95% CI 0.34 to 0.72; I2=0%) than enoxaparin. Results were still statistically significant for all outcomes for both knee and hip subgroup analyses, apart from the analysis of major venous thromboembolism with total hip arthroplasty.
Safety: Rivaroxaban and enoxaparin were not statistically significant different for major bleeding incidence (RR 1.65, 95% CI 0.93 to 2.93; I2=0%). There was also no statistically significant difference in the rates of clinically relevant non-major bleeding, total bleeding events, or drug-related adverse events. Results were not statistically significant for either knee or hip subgroups and were similar to the main meta-analysis.
Sensitivity analysis did not change the main results.
There was no evidence of publication bias.