case reports and signal detection studies showed that enoxaparin was suspected of liver injury after arthroplasty. The objective of this study was to compare enoxaparin and rivaroxaban in their safety (liver injury and bleeding) and efficacy (DVT, PE, and mortality) by performing a meta-analysis of randomized controlled trials that focused in patients after total knee or hip arthroplasty. Methods: A comprehensive search was performed using PubMed, Embase, and Cochrane to retrieve studies that compared enoxaparin and rivaroxaban after arthroplasty. Relative risk (RR) and 95% confidence intervals using Mantel-haenszel approach were reported. Beta-Binomial model was applied to perform sensitivity analysis. The primary endpoints are liver injury and bleeding and the secondary endpoints are incidences of DVT, PE, and mortality. Results: Ten studies were included in the meta-analysis. Compared to rivaroxaban, enoxaparin had a higher risk of liver injury [RR= 1.77; 95% CI: 1.29,2.44]. Use of enoxaparin resulted in a nearly two-fold risk for DVT compared to rivaroxaban and was statistically significant. The pooled estimate for proximal DVT, distal DVT and any DVT were [RR=3.04; 95% CI: 1.34,6.88], [RR=1.72; 95% CI: 1.29,2.29], [RR=2.09; 95% CI :1.48,2.97] respectively. However, there was no statistically significant difference in the rate of symptomatic and asymptomatic DVT, PE, mortality, and bleeding between the two drugs. Conclusions: Enoxaparin was associated with a higher risk for liver injury and rivaroxaban was associated with lower rates of distal DVT, proximal DVT, and any DVT. However, no difference was observed in the risk of bleeding, PE, and mortality. Overall, enoxaparin is less effective and more risky compared to rivaroxaban for people undergoing total knee or hip arthroplasty.
two diagnostic tests resulted in fewer unnecessary revision TJA procedures per patient versus the Serum CRP test alone (TKA -0.056 two-stage revisions, 0.024 misdiagnosed one-stage revisions; THA -0.034 two-stage revisions, 0.011 misdiagnosed one-stage revisions). Conclusions: This novel Alpha Defensin detection test provides an accurate and rapid result to aid in PJI diagnosis and reduces the economic and clinical burden associated with unnecessary revision TJA procedures due to misdiagnosed PJI. This diagnostic test may offer demonstrable economic value to patients, healthcare providers and payers.
Health-related quality of life (HRQoL) was measured by using SF-12v2. Work productivity impairment was estimated by the Work Productivity and Activity Impairment questionnaire. Information about anticancer drugs was obtained from public data. Results: 1,691 (NHWS-2009/2010) and 1,540 (NHWS-2017) patients with cancer were identified. Changes in baseline characters reflected an aging society in Japan. HRQoL improved significantly from 2009/2010 to 2017 except for vitality although the proportion of insomnia and gastrointestinal problems increased (p,0.05). Presenteeism and total activity impairment worsened (p=0.018). We found annual approval of anticancer drugs as new molecular entity after 2010 was 1.8 times more than before 2010. Moreover, variation of mechanisms of action increased by 1.6 times. Conclusions: No major improvement on overall work productivity impairment of cancer patients has been observed in our latest survey despite the increase in the number of treatment options for cancer. Since cancer mortality rates have been improved, early rehabilitation of cancer patients may result in these differences in trends of HRQoL and work productivity in 2017 compare with 2009/2010. We should continue this type of survey and we will need to measure the social impact of early rehabilitation of cancer patients for multi-evaluation of cancer treatments.
Health-related quality of life (HRQoL) was measured by using SF-12v2. Work productivity impairment was estimated by the Work Productivity and Activity Impairment questionnaire. Information about anticancer drugs was obtained from public data. Results: 1,691 (NHWS-2009/2010) and 1,540 (NHWS-2017) patients with cancer were identified. Changes in baseline characters reflected an aging society in Japan. HRQoL improved significantly from 2009/2010 to 2017 except for vitality although the proportion of insomnia and gastrointestinal problems increased (p,0.05). Presenteeism and total activity impairment worsened (p=0.018). We found annual approval of anticancer drugs as new molecular entity after 2010 was 1.8 times more than before 2010. Moreover, variation of mechanisms of action increased by 1.6 times. Conclusions: No major improvement on overall work productivity impairment of cancer patients has been observed in our latest survey despite the increase in the number of treatment options for cancer. Since cancer mortality rates have been improved, early rehabilitation of cancer patients may result in these differences in trends of HRQoL and work productivity in 2017 compare with 2009/2010. We should continue this type of survey and we will need to measure the social impact of early rehabilitation of cancer patients for multi-evaluation of cancer treatments.
There are various explanations for how the Earth’s continents form, develop, and change but challenges remain in fully understanding the driving forces behind plate tectonics on our planet.
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