Efficacy and safety of prolonged use of aspirin or rivaroxaban after surgery for hip fractures

ISRCTN ISRCTN76129839
DOI https://doi.org/10.1186/ISRCTN76129839
Submission date
22/06/2019
Registration date
01/07/2019
Last edited
29/08/2019
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Circulatory System
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data
Record updated in last year

Plain English summary of protocol

Background and study aims
Venous thromboembolism (VTE) is a condition in which a blood clot forms most often in the deep veins of the leg, groin or arm (known as deep vein thrombosis, DVT) and travels in the circulation, lodging in the lungs (known as pulmonary embolism, PE). Together, DVT and PE are known as VTE - a dangerous, potentially deadly medical condition. VTE is a serious complication with a high incidence during and after hospitalization, and it is also an important factor in deaths before and after surgery and unexpected deaths in hospitals. In patients who undergo hip fracture surgery, it is recommended that the duration of drug prevention be at least 10 days and extendable to 11–35 days. Several studies have shown that extended prophylaxis substantially reduces the risk of VTE and recommend a longer prophylaxis duration in all patients undergoing hip fracture surgery. This study compares the use of aspirin and rivaroxaban for the prevention of blood clots following hip surgery.

Who can participate?
Patients with hip fracture who require surgery.

What does the study involve?
All patients were given enoxaparin after the operation and returned to a routine dose the next day until postoperative day five. The patients in the aspirin group received an additional 16 days of thromboprophylaxis with 100 mg of aspirin once daily. The rivaroxaban group was assigned to receive an additional 16 days of thromboprophylaxis with 10 mg of oral rivaroxaban once daily.

What are the possible benefits and risks of participating?
None

Where is the study run from?
Chengdu Fifth People’s Hospital, Chengdu, China

When is the study starting and how long is it expected to run for?
November 2011 to March 2018

Who is funding the study?
Investigator funded

Who is the main contact?
Dr Qiang Huang
huangqiang8111@163.com

Contact information

Dr Qiang Huang
Public

No.33,Ma-shi street
Wenjiang District
Chengdu
Sichuan Province
Chengdu
611130
China

ORCiD logoORCID ID 0000-0003-2559-0249
Phone 028-82722252
Email cds5120@163.com

Study information

Study designInterventional pseudorandomised trial
Primary study designInterventional
Secondary study designCluster randomised trial
Study setting(s)Hospital
Study typePrevention
Participant information sheet Not available in web format, please use contact details to request a participant information sheet.
Scientific titleComparison of the efficacy and safety of aspirin and rivaroxaban following enoxaparin treatment for prevention of VTE after hip fracture surgery
Study acronymCESARFETPVTEHFS
Study objectivesAspirin may have equal efficiency and safety with the direct oral anticoagulant rivaroxaban for the prevention of venous thromboembolism after hip fracture surgery
Ethics approval(s)Approved 16/09/2011, Medical Ethics Committee of Chengdu Fifth People’s Hospital (No. 56 Wanchun East Road, Wenjiang District, Chengdu, Sichuan Province, China; 028-82783867; cdwyiec@163.com), ref: 2019075101
Health condition(s) or problem(s) studiedPrevention of venous thromboembolism after hip fracture surgery
InterventionThe patients were divided into the aspirin group and rivaroxaban group according to odd or even number of the end of the registration number. All patients were given enoxaparin subcutaneous injection after the operation and returned to a routine dose the next day until postoperative day 5. The patients in the aspirin group received an additional 16 days of thromboprophylaxis with 100 mg of aspirin once daily. The rivaroxaban group was assigned to receive an additional 16 days of thromboprophylaxis with 10 mg of oral rivaroxaban once daily.
Intervention typeDrug
Pharmaceutical study type(s)
PhaseNot Applicable
Drug / device / biological / vaccine name(s)Aspirin, rivaroxaban
Primary outcome measure1. Adjudicated venous thromboembolism, which was defined as deep vein thrombosis involving the inferior vena cava to popliteal vein or pulmonary embolism. Ultrasonography of the lower extremity vein is a routine examination. All patients had to be examined before and after surgery. Pulmonary embolism was confirmed by computed tomographic pulmonary angiography, when the patient's symptoms are suspected to be a pulmonary embolism.
2. The primary safety outcome was bleeding, including major or clinically relevant nonmajor bleeding, according to Anderson’s criteria. Patients were followed for 90 days regarding venous thromboembolism and bleeding complications.
Secondary outcome measuresIncidence of health issues in the 90 days following the intervention:
1. Death
2. Myocardial infarction
3. Stroke
4. Wound infection.
Overall study start date08/09/2011
Completion date31/03/2018

Eligibility

Participant type(s)Patient
Age groupAdult
SexBoth
Target number of participantsAspirin grounp (n=198 patients); Rivaroxaban group (n=192 patients)
Key inclusion criteria1. Hip fracture who were diagnosed by X-ray and/or computed tomography.
Key exclusion criteria1. Lower extremity DVT confirmed by preoperative ultrasonography
2. History of thromboembolic disease and undergoing anticoagulant therapy
3. Presence of hemorrhagic diseases and/or a major bleeding history
4. Severe liver or kidney diseases
5. Coagulation disorders
6. Allergy to enoxaparin, aspirin, or rivaroxaban
7. Platelet count less than 100*10^9 cells/L
Date of first enrolment12/11/2011
Date of final enrolment02/01/2018

Locations

Countries of recruitment

  • China

Study participating centre

Chengdu Fifth People’s Hospital
No.33 Ma-shi street
Wenjiang District
Chengdu
Sichuan Province
Chengdu
611130
China

Sponsor information

Department of Orthopedic Surgery, West China Hospital, Sichuan University
Hospital/treatment centre

No. 37, Guo-xue Lane
Wuhou District
Chengdu
Sichuan Province
Chengdu
611430
China

Phone 028-85422430
Email shenbin_1971@163.com
ROR logo "ROR" https://ror.org/007mrxy13

Funders

Funder type

Other

Investigator initiated and funded

No information available

Results and Publications

Intention to publish date01/10/2019
Individual participant data (IPD) Intention to shareYes
IPD sharing plan summaryAvailable on request
Publication and dissemination planThe intention is to publish the results of this study, in peer-reviewed journals.The results will be made available online, if permitted by journal policies.
IPD sharing planThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request

Editorial Notes

29/08/2019: Internal review.
05/07/2019: Internal review.
01/07/2019: Trial's existence confirmed by Medical Ethics Committee of Chengdu Fifth People’s Hospital.