Nonmajor orthopedic surgery, especially of the lower limbs may cause reduced mobility of the patients for some time. This results in an increased risk of developing venous thromboembolism.

The author wrote, “There is a lack of consensus among the professionals on thromboprophylaxis in patients undergoing nonmajor orthopedic surgery.  Therefore, we conducted Prophylaxis in Nonmajor Orthopaedic Surgery to compare the rivaroxaban and enoxaparin in preventing major venous thromboembolism after the patients have undergone lower-limb nonmajor surgery.”

The study analysis the comparative effect of rivaroxaban and enoxaparin to prevent or reduce the risk of such post-surgical complications.

The study was an international, parallel-group, randomized, double-blind, noninferiority trial. The patients included in the study were undergoing lower-limb nonmajor orthopedic surgery and were considered at increased risk of developing thromboembolism. Based on the judgment of the investigator, the patients were either given rivaroxaban or enoxaparin. The primary outcome of the study was major venous thromboembolism, which was the combined effect of pulmonary embolism, symptomatic distal or proximal deep-vein thrombosis, or venous thromboembolism–related death during the treatment period. The primary outcome also includes asymptomatic proximal deep-vein thrombosis at the end of treatment.

The study included a total of 3604 patients. Out of these 1809 patients receive rivaroxaban while enoxaparin was administered in 1795 patients. 1.1% of patients (18 of 1640) in the enoxaparin group and 0.2% patients (4 of 1661) experienced major venous thromboembolism The incidence of bleeding was similar in both the groups and did not differ significantly

The risk of patients undergoing nonmajor orthopedic surgery has an increased risk of venous thromboembolism. Anticoagulants are used to manage this risk. The study concludes that rivaroxaban was more effective in the prevention of venous thromboembolic events than enoxaparin after nonmajor orthopedic surgery of the lower limbs during a period of immobilization.


Samama CM, Laporte S, Rosencher N, Girard P, Llau J, Mouret P, Fisher W, Martínez-Martín J, Duverger D, Deygas B, Presles E, Cucherat M, Mismetti P; PRONOMOS Investigators. Rivaroxaban or Enoxaparin in Nonmajor Orthopedic Surgery. N Engl J Med. 2020


Disease Condition ,Therapeutic Modality ,Coronary Artery Disease,Peripheral vascular diseases,Pharmacotherapeutics,Coronary Artery Vasospasm,Myocardial Infarction,Ischemic Heart Disease,Deep Venous Thrombosis,Thrombolysis in Myocardial Infarction (TIMI) Score