Safety and efficacy of new anticoagulants for the prevention of venous thromboembolism after hip and knee arthroplasty: a meta-analysis
Brett Venker, PharmD,1,2 Beejal R. Ganti, PharmD,1,3 Hannah Lin, BA,1,4 Elizabeth D. Lee, MMS, PA-C,1,5 Ryan M. Nunley, MD,1 and Brian F. Gage, MD, MSc1Hip Knee
Background
Venous thromboembolism (VTE) is a common and potentially fatal complication of arthroplasty.
Methods
We reviewed randomized trials to determine which anticoagulant has the best safety and efficacy in hip/knee arthroplasty patients. We searched PubMed, MEDLINE, and EMBASE through January 2016.
Results
Compared to enoxaparin (most commonly dosed 40 mg once daily), the relative risk (RR) of VTE was lowest for edoxaban 30 mg once daily (0.49, 95% CI 0.32–0.75), fondaparinux 2.5 mg once daily (0.53, 95% CI 0.45–0.63), and rivaroxaban 10 mg once daily (0.55, 95% CI 0.46–0.66), and highest for dabigatran 150 mg once daily (1.19, 95% CI 0.98–1.44). The RR of major/clinically relevant bleeding was lowest for apixaban 2.5 mg twice daily (0.84, 95% CI 0.70–0.99), and highest for rivaroxaban (1.27, 95% CI 1.01–1.59) and fondaparinux (1.64, 95% CI 0.24–11.35). Fondaparinux was the only agent that was more effective than enoxaparin 30 mg twice daily (VTE RR = 0.58, 95% CI 0.43–0.76).
Conclusion
With the possible exception of apixaban, newer anticoagulants that lower the risk of post-operative VTE increase bleeding.
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