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. 2015 Sep 1;5(4):27889.
doi: 10.3402/jchimp.v5.27889. eCollection 2015.

Thromboprophylaxis with apixaban and the risk of pulmonary embolism in patients undergoing knee replacement surgery

Madan Raj Aryal  1 , Anil Pandit  2 , Sushil Ghimire  1 , Ranjan Pathak  1 , Paras Karmacharya  1 , Dilli Ram Poudel  1 , Fadi E Shamoun  3
Affiliations

Thromboprophylaxis with apixaban and the risk of pulmonary embolism in patients undergoing knee replacement surgery

Madan Raj Aryal et al. J Community Hosp Intern Med Perspect. .

Abstract

Background: Apixaban, a novel oral anticoagulant, is also used for deep vein thrombosis (DVT) prophylaxis. In this study, we sought to critically evaluate the differences in the rates of symptomatic DVT and bleeding, and analyze the rates of pulmonary embolism (PE) in subgroups of patients from ADVANCE I and II trials given their similar indication and design.

Methods: Studies were identified through electronic literature searches of MEDLINE, clinicaltrial.gov, SCOPUS, and EMBASE up to January 2014. Phase III RCTs involving use of apixaban and enoxaparin for thromboprophylaxis in patients undergoing total knee or hip replacement were included. Study-specific odds ratios were calculated and between-study heterogeneity was assessed using the I (2) statistics.

Results: In three studies involving 11,659 patients, the risk of symptomatic DVT (pooled OR 0.38, 95% CI 0.16-0.90, I (2)=0%, p=0.03) and bleeding (pooled OR 0.87, 95% CI 0.77-0.99, I (2)=0%, p=0.03) was less in apixaban group compared to the enoxaparin group. However, it was interesting to note that on subgroup analysis, the risk of PE was higher with apixaban when used for thromboprophylaxis in knee replacement surgery (pooled OR 2.58, 95% CI 1.10-6.04, I (2)=0%, p=0.03).

Conclusion: Apixaban was found to be associated with lower risk of symptomatic DVT and bleeding compared to enoxaparin when used for thromboprophylaxis in patients undergoing knee and hip replacement surgeries. However, it was associated with higher risk of PE in patients undergoing knee replacement.

Keywords: apixaban; arthroplasty; hip replacement; knee replacement; meta-analysis.

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Figures

Fig. 1
Fig. 1
Flow chart describing systematic literature search and study selection process.
Fig. 2
Fig. 2
Meta-analysis of symptomatic DVT. Comparator: apixaban versus enoxaparin.
Fig. 3
Fig. 3
Meta-analysis of bleeding events. Comparator: apixaban versus enoxaparin.
Fig. 4
Fig. 4
Meta-analysis of pulmonary embolism. Comparator: apixaban versus enoxaparin.
See this image and copyright information in PMC

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References

    1. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition) Chest. 2008;133(6 Suppl):381S–453S. - PubMed
    1. Levine MN, Hirsh J, Gent M, Turpie AG, Leclerc J, Powers PJ, et al. Prevention of deep vein thrombosis after elective hip surgery. A randomized trial comparing low molecular weight heparin with standard unfractionated heparin. Ann Intern Med. 1991;114(7):545–51. - PubMed
    1. Hull R, Raskob G, Pineo G, Rosenbloom D, Evans W, Mallory T, et al. A comparison of subcutaneous low-molecular-weight heparin with warfarin sodium for prophylaxis against deep-vein thrombosis after hip or knee implantation. N Engl J Med. 1993;329(19):1370–6. - PubMed
    1. Ansell J, Hirsh J, Poller L, Bussey H, Jacobson A, Hylek E. The pharmacology and management of the vitamin K antagonists: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):204S–33S. - PubMed
    1. Dahl OE, Pleil AM. Investment in prolonged thromboprophylaxis with dalteparin improves clinical outcomes after hip replacement. J Thromb Haemost. 2003;1(5):896–906. - PubMed

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