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European Journal of Orthopaedic Surgery & Traumatology

Erschienen in:

10.08.2024 | General Review

Antithrombotic prophylaxis following total knee arthroplasty: a level I Bayesian network meta-analysis

verfasst von: Filippo Migliorini, Nicola Maffulli, Erlis Velaj, Andreas Bell, Daniel Kämmer, Jörg Eschweiler, Ulf Krister Hofmann

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 6/2024

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Abstract

Introduction

Venous thromboembolism (VTE) is a major concern following total knee arthroplasty (TKA). The optimal pharmacological prophylaxis remains, however, controversial. The present investigation compared several non-vitamin K antagonist oral anticoagulants commonly employed as VTE prophylaxis following TKA. A Bayesian network meta-analysis was conducted to compare apixaban, aspirin, dabigatran, edoxaban, enoxaparin, fondaparinux, and rivaroxaban. The outcomes of interest were to compare the rate of deep venous thrombosis (DVT), pulmonary embolism (PE), and major and minor haemorrhages.

Methods

This study was conducted according to the PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-Analyses of Health Care Interventions. In March 2024, PubMed, Web of Science, and Google Scholar were accessed with no time constraints. All randomised controlled trials (RCTs) comparing two or more drugs for the prevention of VTE following TKA were considered for inclusion.

Results

Data from 29,678 patients were collected. Of them, 67% (19,884 of 29,678 patients) were women. The mean age of the patients was 66.8 ± 2.8 years, and the mean BMI was 29.2 ± 1.5 kg/m². There was comparability in age, sex, and BMI at baseline. Apixaban 5 mg, dabigatran 220 mg, and rivaroxaban 10 mg were the most effective in reducing the rate of DVT. Apixaban 5 mg, enoxaparin 60 mg, and rivaroxaban 40 mg were the most effective in reducing the rate of PE. Apixaban 5 mg, rivaroxaban 10 mg, and apixaban 10 mg were associated with the lowest rate of major haemorrhages. Apixaban 5 mg and 20 mg, and dabigatran 220 mg were associated with the lowest rate of minor haemorrhages.

Conclusion

Administration of apixaban 5 mg demonstrated the best balance between VTE prevention and haemorrhage control following TKA.

Level of evidence

Level I, network meta-analysis of RCTs.

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Titel: Antithrombotic prophylaxis following total knee arthroplasty: a level I Bayesian network meta-analysis
verfasst von: Filippo Migliorini
Nicola Maffulli
Erlis Velaj
Andreas Bell
Daniel Kämmer
Jörg Eschweiler
Ulf Krister Hofmann
Publikationsdatum: 10.08.2024
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 6/2024
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-024-04071-w

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Antithrombotic prophylaxis following total knee arthroplasty: a level I Bayesian network meta-analysis