Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty?

Clinical trials and meta-analyses have suggested that aspirin may be effective for the prevention of venous thromboembolism (proximal deep-vein thrombosis or pulmonary embolism) after total hip or total knee arthroplasty, but comparisons with direct oral anticoagulants are lacking for prophylaxis beyond hospital discharge.

This report is of a trial that addresses this issue. A total of 3,424 patients (1,804 undergoing total hip arthroplasty and 1,620 undergoing total knee arthroplasty) were enrolled in the trial. All received oral rivaroxaban (10mg) until the fifth postoperative day. The patients were then randomised to continue rivaroxaban or switch to aspirin (81mg) daily for nine days (knee patients) or 30 days for the hip patients.

It was concluded that among patients who received five days of rivaroxaban prophylaxis after total hip or total knee arthroplasty, extended prophylaxis with aspirin was not significantly different from rivaroxaban in the prevention of symptomatic venous thromboembolism. Clinically important bleeding risks were similar in both groups of patients.

N Engl J Med 2018; 378: 699–707

Adjunctive rifampicin for Staphylococcus aureus bacteraemia

Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. Adjunctive rifampicin has been hypothesised to improve results when used in addition to standard treatment. This report is of a randomised trial which aimed to clarify this issue.

Seven hundred and fifty-eight patients were involved. All received treatment with an anti-staphylococcal drug—penicillin, flucloxacillin or methicillin. Those with methicillin-resistant organisms were treated with a glycopeptide (vancomycin). Half of the patients were also treated with rifampicin and the other half a placebo.

The result of this trial was that adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia.

Lancet 2018; 391:668–78

Burden of atrial fibrillation in Māori and Pacific people in New Zealand

Atrial fibrillation (AF) is a major risk factor for stroke and cardiovascular events. Previous studies suggest that Māori and Pacific people have a higher incidence of AF than people of European ancestry.

Data obtained from 37 New Zealand general practices is reviewed in this study, which involved 135,840 subjects, including 19,918 Māori and 43,634 Pacific people. The incidence of AF was found to be similar to that noted in other countries, and strongly age-related. However, it was discovered that AF was diagnosed 10 years earlier in the Polynesian patients compared with their European counterparts— Māori 60 years, Pacific 61 years and European 71 years.

In view of these findings it was suggested that AF screening and stroke thromboprophylaxis in Māori and Pacific people could start below the age of 65 years in New Zealand.

Internal Medicine Journal 2018; 48:301–309

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