***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Post-operative complications after total hip or knee replacement can delay recovery , prolong hospitalisation , increase rates of re-admission and , in the most severe cases , lead to long-term disability or even death . In this analysis of pooled data from four large , r and omised , phase III clinical trials that compared the oral , direct Factor Xa inhibitor rivaroxaban with subcutaneous enoxaparin for the prevention of venous thromboembolism after total hip or knee replacement ( n = 12,729 ) , the incidence of complications , including bleeding and adverse events related to surgery ( such as wound infection , wound dehiscence and haemarthrosis ) are reported . Interventions and procedures relating to surgery are also compared between the groups . Bleeding events , including excessive wound haematoma and surgical-site bleeding , occurred at similar rates in the rivaroxaban and enoxaparin groups . Over the total study duration , adverse surgical events occurred at a similar rate in the rivaroxaban group compared with the enoxaparin group after total knee replacement ( 2.26 % vs. 2.69 % , respectively ) and total hip replacement ( 1.48 % vs. 1.65 % , respectively ) . Blood loss , wound drainage and transfusion requirements were also similar between the two groups . This analysis shows that the incidence of adverse surgical events with rivaroxaban was similar to enoxaparin Rivaroxaban has been recommended for routine use as a thromboprophylactic agent in patients undergoing lower-limb arthroplasty . However , trials supporting its use have not fully evaluated the risks of wound complications . This study of 1048 total hip/knee replacements records the rates of return to theatre and infection before and after the change from a low molecular weight heparin ( tinzaparin ) to rivaroxaban as the agent of chemical thromboprophylaxis in patients undergoing lower-limb arthroplasty . During a period of 13 months , 489 consecutive patients undergoing lower-limb arthroplasty received tinzaparin and the next 559 consecutive patients received rivaroxaban as thromboprophylaxis . Nine patients in the control ( tinzaparin ) group ( 1.8 % , 95 % confidence interval 0.9 to 3.5 ) returned to theatre with wound complications within 30 days , compared with 22 patients in the rivaroxaban group ( 3.94 % , 95 % confidence interval 2.6 to 5.9 ) . This increase was statistically significant ( p = 0.046 ) . The proportion of patients who returned to theatre and became infected remained similar ( p = 0.10 ) . Our study demonstrates the need for further r and omised controlled clinical trials to be conducted to assess the safety and efficacy of rivaroxaban in clinical practice , focusing on the surgical complications as well as the potential prevention of venous thromboembolism Background This study aim ed to assess whether the efficacy of tranexamic acid ( TXA ) would be altered when rivaroxaban or enoxaparin was used for thromboprophylaxis in primary total knee replacement ( TKR ) . It was hypothesized that the hemostatic effect of TXA would be better with the use of enoxaparin . Material / Methods A r and omized clinical trial was conducted on 194 patients undergoing primary TKR for osteoarthritis . An intravenous dose of 15 mg/kg ( TXA ) and 1 g topical TXA were used . Patients r and omly received enoxaparin or rivaroxaban prophylaxis when the drainage was less than 30 ml/h 6–8 h postoperatively . The primary endpoint was hidden blood loss ( HBL ) . Indexes of total blood loss drainage , hemoglobin drop , transfusion , range of motion ( ROM ) , HSS score , VAS pain score , knee swelling , length of hospital stay ( LOHS ) , incidence of venous thromboembolism , major/minor bleeding , and wound complications were also compared between the groups . Results More than 80 % of patients initiated anticoagulation within 6 h postoperatively . No statistically significance difference was detected in terms of HBL ( 679.0±205.6 vs. 770.5±206.1 , p=.062 ) or other bleeding index , ROM , or LOHS . The motion VAS pain score and knee swelling ( 16.7 % vs. 6.1 % , p=.021 ) were significantly lower , and HSS score at discharge was higher in the enoxaparin group . The rivaroxaban group had less asymptomatic deep venous ( 4.1 % vs. 0 % , p=.121 ) and muscular venous thrombosis ( 2.1 % vs. 9.2 % , p=.033 ) ; more ecchymosis ( 13.5 % vs. 10.2 % , p=.472 ) , and wound complications ( 13.5 % vs. 6.1 % , p=.082 ) . No episodes of transfusion , pulmonary embolism , or major bleeding occurred in either group . Conclusions More attention should be paid to the increased risk of wound complications and knee swelling associated with rivaroxaban , although the hidden blood loss was similar in both groups Purpose Venous thromboembolism is a common complication after major orthopedic surgery . When prescribing anticoagulant prophylaxis , clinicians weigh the benefits of thromboprophylaxis against bleeding risk and other adverse events . Previous benefit – risk analyses of the REgulation of Coagulation in ORthopaedic surgery to prevent Deep vein thrombosis and pulmonary embolism ( RECORD ) r and omized clinical studies of rivaroxaban versus enoxaparin  after total hip ( THA ) or knee ( TKA ) arthroplasty generally used pooled THA and TKA results , counted fatal bleeding as both an efficacy and a safety event , and included the active and placebo-controlled portions of RECORD2 , which might confound benefit – risk assessment s. We conducted a post hoc analysis without these constraints to assess benefit – risk for rivaroxaban versus enoxaparin in the RECORD studies . Patients and methods Data from the safety population of the two THA and two TKA studies were pooled separately . The primary analysis compared the temporal course of event rates and rate differences between rivaroxaban and enoxaparin prophylaxis for symptomatic venous thromboembolism plus all-cause mortality ( efficacy events ) versus nonfatal major bleeding ( safety events ) . Additionally , these rates were used to derive measures of net clinical benefit , number needed to treat ( NNT ) , and number needed to harm ( NNH ) for these two end points . Results After THA or TKA , and compared with enoxaparin , rivaroxaban therapy result ed in more efficacy events prevented than safety events caused , with benefits exceeding harms early and throughout treatment and follow-up . Relative to enoxaparin , rivaroxaban treatment prevented six efficacy events per harm event caused for THA , with NNT = 262/NNH = 1,711 . For TKA , rivaroxaban treatment prevented four to five efficacy events per harm event caused , with NNT = 102/NNH = 442 . Sensitivity analysis that included surgical-site bleeding result ed in NNH = 345 for THA and NNH = 208 for TKA . Conclusion In the RECORD studies , considering death , symptomatic venous thromboembolism , and major bleeding , rivaroxaban result ed in greater benefits than harms compared with enoxaparin . When incorporating surgical-site bleeding , rivaroxaban also results in greater benefit than harm for TKA and is balanced with enoxaparin for THA OBJECTIVES To compare the main efficacy and safety endpoints of the pivotal r and omised clinical trials ( RCTs ) on venous thromboembolism ( VTE ) prevention after total hip ( THR ) or knee ( TKR ) replacement with the new oral anticoagulants ( NAs ) versus enoxaparin . METHODS A pool- analysis of 10 RCTs that included 32.144 r and omised patients was performed . Efficacy outcomes were total VTE and all-cause mortality , major VTE , and proximal DVT . Safety outcomes were major bleeding , and clinical ly relevant ( major or non-major ) bleeding . RESULTS Overall , a significant effect favouring NAs was found for the primary efficacy outcome ( RR 0.71 ; 95%CI 0.56 - 0.90 ) , major VTE ( RR 0.59 ; 95%CI 0.41 - 0.84 ) , and proximal DVT ( RR 0.51 ; 95%CI 0.35 - 0.76 ) . Compared to enoxaparin 40 mg QD , rivaroxaban showed superiority ( RR 0.50 ; 95%CI 0.34 - 0.73 ) , followed by apixaban ( RR 0.63 ; 95%CI 0.36 - 1.01 ) and dabigatran ( RR 1.02 ; 95%CI 0.86 - 1.20 ) . There was significant heterogeneity among trials and subgroups analysed for these efficacy outcomes . Major bleeding ( RR 1.04 ; 95 % CI 0.74 - 1.46 ) and clinical ly relevant bleeding ( RR 1.03 ; 95%CI 0.88 - 1.21 ) was similar with NAs or enoxaparin . Rivaroxaban showed a trend toward more major bleeding episodes than enoxaparin ( RR 1.88 ; 95%CI 0.92 - 3.82 ) and apixaban showed the lowest clinical ly relevant bleeding risk ( RR 0.81 ; 95%CI 0.64 - 1.01 ) . CONCLUSIONS Overall , NAs showed more efficacy and same safety when compared to the recommended dose of enoxaparin after THR and TKR . There are little differences in efficacy and bleeding risk among NAs and the type of prophylaxis that should be analysed further This study aim ed to compare the efficacy and safety of aspirin , rivaroxaban and low-molecular-weight heparin ( LMWH ) for post total knee arthroplasty ( TKA ) deep vein thrombosis ( DVT ) prophylaxis . Between July 2011 and July 2013 , a prospect i ve r and omized controlled trial was performed on 324 patients with osteoarthritis who underwent primary unilateral TKA . Twelve hours after the surgery , Group A was given oral rivaroxaban at a dose of 10 mg/day . Group B was given subcutaneous LMWH at a dose of 4000 AxaIU ( 0.4 ml)/day and Group C was given oral aspirin at a dose of 100 mg/day . All three groups were treated for 14 days , and all of the patients were followed for 4 weeks . The incidence of DVT , dominant/hidden blood loss , the incidence of wound complications and the incidence of subcutaneous ecchymosis in the affected extremities were compared between the three groups . The incidence of DVT was lower in Group A compared with the other two groups [ 3 ( 2.94 % ) vs. 14 ( 12.50 % ) , P = 0.029 ; 3 ( 2.94 % ) vs. 18 ( 16.36 % ) , P = 0.017 ] . However , hidden blood loss [ 1.71 ( 1.19–2.97 ) vs. 1.18 ( 0.77–2.31 ) , P = 0.009 ; 1.71 ( 1.19–2.97 ) vs. 1.30 ( 0.61–2.43 ) , P = 0.004 ] and wound complications [ 5 ( 4.90 ) vs. 3 ( 2.67 ) , P = 0.027 ; 5 ( 4.90 ) vs. 2 ( 1.82 ) , P = 0.014 ] were more common in Group A than in the other groups . There were no significant differences between Group B and Group C in the incidence of DVT [ 14 ( 12.50 % ) vs. 18 ( 16.36 % ) , P = 0.831 ] , hidden blood loss [ 1.18 ( 0.77–2.31 ) vs. 1.30 ( 0.61–2.43 ) , P = 0.327 ] or wound complications [ 3 ( 2.67 ) vs. 2 ( 1.82 ) , P = 0.209 ] . No significant differences in the incidence of limb swelling were found between the three groups [ 38 ( 37.25 % ) vs. 28 ( 25.00 % ) vs. 24 ( 21.82 % ) , P = 0.247 ] . Group A had a higher incidence of subcutaneous ecchymosis in the affected extremities than Group C [ 74 ( 72.55 % ) vs. 54 ( 49.09 % ) , P = 0.039 ] , but there were no significant differences between Groups A and B [ 74 ( 72.55 % ) vs. 62 ( 55.36 % ) , P = 0.193 ] or between Groups B and C [ 62 ( 55.36 % ) vs. 54 ( 49.09 % ) , P =  
    Output:
    
In the studies analyzed , considering symptomatic venous thromboembolism , rivaroxaban result ed in higher benefits when compared to enoxaparin