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Review
. 2017 Feb;32(2):645-652.
doi: 10.1016/j.arth.2016.09.033. Epub 2016 Oct 5.

Safety and Efficacy of New Anticoagulants for the Prevention of Venous Thromboembolism After Hip and Knee Arthroplasty: A Meta-Analysis

Brett T Venker  1 , Beejal R Ganti  2 , Hannah Lin  3 , Elizabeth D Lee  4 , Ryan M Nunley  5 , Brian F Gage  6
Affiliations
Review

Safety and Efficacy of New Anticoagulants for the Prevention of Venous Thromboembolism After Hip and Knee Arthroplasty: A Meta-Analysis

Brett T Venker et al. J Arthroplasty. 2017 Feb.

Abstract

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 and 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% confidence interval [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 postoperative VTE increase bleeding.

Keywords: anticoagulant; arthroplasty; bleed; deep vein thrombosis; meta-analysis; thromboembolism.

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Figures

Figure 1
Figure 1
Selection process for trials included in meta-analyses
Figure 2
Figure 2
Pooled Relative Risks of VTE (Venous Thromboembolism) with Newer Anticoagulants Compared to Enoxaparin Abbreviations: RR, relative risk; VTE, venous thromboembolism
Figure 3
Figure 3
Pooled RR of Major/Clinically Relevant Bleeding for Newer Anticoagulants Compared to Enoxaparin
Figure 4
Figure 4
Relative risk of bleeding vs. relative risk of VTE *The black circle at the origin (1.0, 1.0) shows enoxaparin, the referent therapy. The relative risk of bleeding—either major or non-major clinical relevant bleeding (vertical axis) and the relative risk of venous thromboembolism (VTE) (horizontal axis). Each cross shows the 95% confidence intervals of the relative risk from a meta-analysis.
See this image and copyright information in PMC

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