ReviewSafety and Efficacy of New Anticoagulants for the Prevention of Venous Thromboembolism After Hip and Knee Arthroplasty: A Meta-Analysis
Section snippets
Data Sources and Searches
We searched PubMed, MEDLINE (through PubMed), and EMBASE through January 2016 using the following keywords: (apixaban OR dabigatran OR rivaroxaban OR fondaparinux OR edoxaban) AND (hip OR knee) AND arthroplasty. Additionally, references of included studies were reviewed as potential candidate trials. No betrixaban or darexaban trials met our inclusion criteria.
Study Selection
Inclusion criteria were as follows: double-blinded, randomized, controlled trials that enrolled adult patients within 48 hours of
Results
Initial searches located 435 trials. After applying inclusion/exclusion criteria (Fig. 1), 4 apixaban trials, 4 dabigatran trials, 4 fondaparinux trials, 4 rivaroxaban trials, and 2 edoxaban trials were included. All 18 trials were sponsored by the manufacturers. The control in every trial was enoxaparin (given subcutaneously). Although the enoxaparin regimen varied across trials, its consistent use enabled us to compare the safety and efficacy of each new anticoagulant against enoxaparin. With
Discussion
As compared to subcutaneous enoxaparin, 4 newer anticoagulants reduced the rate of VTE after arthroplasty (Fig. 2). Their RR (95% CI) were as follows: apixaban, 0.71 (0.52-0.96); rivaroxaban, 0.55 (0.46-0.66); fondaparinux, 0.53 (0.45-0.63); and edoxaban, 0.49 (0.32-0.75). Apixaban also protected against major/clinically relevant bleeding: RR (95% CI) of 0.84 (0.70-0.99). In contrast, rivaroxaban increased major/clinically relevant bleeds (RR = 1.27; 95% CI, 1.01-1.59). The effect of
Acknowledgments
Funding for this research was provided by the NIH grant HL R01 HL097036, UL1 RR024992, and TL1 RR024995.
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A poster of the abstract and preliminary results were presented at the 2012 American College of Clinical Pharmacy in Hollywood, Florida.
No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.09.033.