Open AccessThe Efficacy and Safety of Pharmacological Prophylaxis of Venous Thromboembolism Following Elective Knee or Hip Replacement
Author(s) -
Aloni Cohen,
Pieter Drost,
Nick Marchant,
Stephen Mitchell,
Michelle Orme,
Dale A. Rublee,
Teresa A. Simon,
Alex J. Sutton
Publication year - 2012
Publication title -
clinical and applied thrombosis/hemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.643
H-Index - 53
eISSN - 1938-2723
pISSN - 1076-0296
DOI - 10.1177/1076029612437579
Subject(s) - apixaban , medicine , dabigatran , rivaroxaban , knee replacement , hip replacement , odds ratio , confidence interval , randomized controlled trial , arthroplasty , venous thromboembolism , anesthesia , surgery , warfarin , atrial fibrillation , thrombosis
The present systematic review was conducted to assess the efficacy and safety of apixaban versus other anticoagulants, for the prevention of venous thromboembolism (VTE) following total hip replacement (THR) and total knee replacement (TKR) surgery. Electronic databases were interrogated to identify relevant randomized controlled trials. A series of direct/indirect comparisons and a network meta-analysis were conducted. Indirect comparisons found that the odds ratio of “all VTE and all-cause death” were significantly higher for dabigatran than for apixaban in patients with THR (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.50-4.21) and TKR (OR, 1.72; 95% CI, 1.22-2.42). Rivaroxaban showed similar efficacy to apixaban in patients with THR and TKR (OR, 0.69; 95% CI, 0.38-1.25 and OR, 0.83; 95% CI, 0.57-1.19, respectively). No significant differences were observed in bleeding outcomes between treatments. The novel anticoagulants apixaban, rivaroxaban, and dabigatran demonstrated similar or improved efficacy and similar safety compared with current therapies in this indication.