Oral direct factor Xa inhibitor versus enoxaparin for thromboprophylaxis after hip or knee arthroplasty: Systemic review, traditional meta-analysis, dose–response meta-analysis and network meta-analysis

Feng, Weili; Wu, Kezhou; Liu, Zhaoyong; Kong, Gengbin; Deng, Zhihua; Chen, Shubiao; Wu, Yu-Shiang; Chen, Mengmeng; Liu, Shuo; Wang, Hu

doi:10.1016/j.thromres.2015.10.009

Cited by 56 publications

(52 citation statements)

References 41 publications

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“…Many systematic reviews and meta-analyses have been published in this area. Recently, an influential network meta-analysis aiming to compare any two direct factor Xa inhibitors reviewed the efficacy and safety of thromboprophylaxis following total hip or knee replacement [18]. The study included rivaroxaban, apixaban, betrixaban, darexaban, and edoxaban and indicated that the effects of these agents on total VTE risk ranked from low to high as follows: rivaroxaban, apixaban, edoxaban, enoxaparin, darexaban, and betrixaban.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and Tolerability of Anticoagulants for Thromboprophylaxis after Major Joint Surgery: a Network Meta-Analysis

Wang¹,

Zheng²,

Zhao³

et al. 2017

Cell Physiol Biochem

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Background/Aims: Venous thromboembolism (VTE) is the most common complication after major joint surgery. VTE can easily develop into pulmonary embolism (PE), leading to cardiopulmonary dysfunction or sudden death. We aimed to comprehensively analyse the thromboprophylactic drugs that are used to prevent thrombosis and reduce bleeding risk. Methods: We searched the PubMed, EMBASE, and Cochrane databases for randomized controlled trials that evaluated the use of thromboprophylaxis after major joint surgery. The major outcomes were the numbers of all-cause VTE and bleeding events, and the secondary outcomes were major VTE and major bleeding/clinically relevant non-major bleeding events. A random-effects network meta-analysis was used to assess the effectiveness and tolerability of each anticoagulant after major joint surgery. Results: We included 104 trials that assessed 110,643 patients in our meta-analysis. The cluster ranking of major outcomes indicated that FXI-ASO, ardeparin, aspirin, and apixaban were ideal for preventing all-cause VTE and avoiding all bleeding events. Nadroparin, recombinant hirudin, and rivaroxaban effectively inhibited VTE but were associated with a high risk of bleeding. For secondary outcomes, we found that betrixaban, dalteparin, warfarin, and eribaxaban were ideal for preventing major VTE and reducing major bleeding, while rivaroxaban effectively inhibited major VTE but was associated with a high risk of major/clinically relevant non-major bleeding. A sensitivity analysis showed that the effect of apixaban was more robust for major outcomes, while aspirin was more robust for preventing all-cause bleeding events. In secondary outcomes, the effect of warfarin was more robust, while apixaban was still considered an ideal treatment to inhibit major VTE and bleeding events. Conclusion: Our study indicates that FXI-ASO, ardeparin, aspirin, and apixaban are ideal for preventing all-cause VTE and reducing all bleeding events, among which apixaban is the most reliable. Betrixaban, dalteparin, warfarin, and eribaxaban are ideal for preventing major VTE and reducing major/clinically relevant non-major bleeding events, among which warfarin is the most reliable.

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Section: Introductionmentioning

confidence: 99%

Effectiveness and Tolerability of Anticoagulants for Thromboprophylaxis after Major Joint Surgery: a Network Meta-Analysis

Wang¹,

Zheng²,

Zhao³

et al. 2017

Cell Physiol Biochem

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“…The availability of different regimens of comparators complicates an integrated assessment of the overall efficacy and safety of new agents relative to the current standard of care, as well as indirect comparisons among the new agents, but this factor has not always been considered in published meta‐analyses for single1, 2, 3, 4, 5, 6, 7 or multiple8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 agents. Dose regimen of the comparator has been acknowledged as a potential source of heterogeneity for a number of previous analyses 1, 2, 3, 5, 6, 10, 11, 12, 13, 14, 18.…”

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confidence: 99%

“…Dose regimen of the comparator has been acknowledged as a potential source of heterogeneity for a number of previous analyses 1, 2, 3, 5, 6, 10, 11, 12, 13, 14, 18. These analyses have generally evaluated the dose regimen of the comparator in a sensitivity assessment that did not support separate comparisons by dose regimen.…”

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confidence: 99%

Direct Oral Anticoagulants Vs. Enoxaparin for Prevention of Venous Thromboembolism Following Orthopedic Surgery: A Dose–Response Meta‐analysis

Boyd

DiCarlo

Mandema³

2017

Clinical Translational Sci

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We carried out a dose–response model‐based meta‐analysis to assess venous thromboembolism (VTE) and bleeding with factor Xa (FXa) inhibitors (apixaban, edoxaban, rivaroxaban) and a thrombin inhibitor (dabigatran) compared with European (EU) (40 mg q.d.) and North American (NA) (30 mg Q12H) dose regimens of a low molecular weight heparin (enoxaparin) following orthopedic surgery. Statistically significant differences in both VTE and bleeding outcomes were found between the NA and EU doses of enoxaparin, with odds ratios (95% confidence interval) for the NA vs. EU dose of 0.73 (0.71–0.76) and 1.20 (1.14–1.29) for total VTE and major bleeding, respectively. At approved doses, estimated odds ratios vs. both doses of enoxaparin for the three FXa inhibitors (range: 0.35–0.75 for VTE; 0.76–1.09 for bleeding) compared with those for dabigatran (range: 0.66–1.21 for VTE; 1.10–1.38 for bleeding) suggested generally greater efficacy and less bleeding for the FXa inhibitors.

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“…the most recent version of the American College of Chest Physicians guidelines, published in 2012, recommends thromboprophylaxis with anticoagulants for a minimum of 10 to 14 days in patients undergoing tHA (grade 1B), which should be extended in the outpatient period for ≤35 days from the day of surgery (grade 2) (4). Randomized controlled trials have recently demonstrated that these novel agents are at least as effective as LMWHs and are not associated with an increased incidence of clinically significant bleeding (12,28,29). thus, dabigatran, rivaroxaban and fondaparinux -the new inhibitors of thrombin or factor Xa -represent a valid alternative to LMWHs.…”

Section: Discussionmentioning

confidence: 99%

“…on the other hand, it is not known whether dabigatran administration alters the thromboelastogram (tEG) trace. the results of studies comparing dabigatran and enoxaparin on the basis of the evidence from REMo DEL (the prevention of venous thromboembolism after total knee replacement trial) and REnoVAt (the prevention of venous thromboembolism after total hip replacement trial) (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) have shown that dabigatran has the same efficacy as a single administration of 40 mg of enoxaparin; instead, REMoBiLiZE (the prevention of venous thromboembolism after total knee arthroplasty trial) showed that dabigatran could meet the criteria of non-inferiority to a 30 mg twice daily dose of enoxaparin. the pharmacological profile of rivaroxaban has also been extensively studied (14,31,32).…”

Section: Discussionmentioning

confidence: 99%

Patient compliance with new oral anticoagulants after major orthopaedic surgery: rivaroxaban and dabigatran compared with subcutaneous injection of fondaparinux

Benedetto

Vetrugno

Franceschi

et al. 2016

Joints

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Purpose: the main purpose of our study was to compare patient compliance with the orally administered new oral anticoagulants (noCs) dabigatran and rivaroxaban compared with subcutaneously injected fondaparinux after major orthopaedic surgery, and to assess patient preference for the oral vs subcutaneous administration route. Methods: prophylactic antithrombotic drug therapy with dabigatran (group D; GD, n=32 patients), rivaroxaban (group R; GR, n=38 patients) or fondaparinux (group F; GF, n=30 patients), to prevent deep vein thrombosis, was started immediately after surgery in 100 patients submitted to total hip arthroplasty. Results: the patients had a mean age of 68.7±11 years and 62% were female. in GD, 87.5% of patients indicated that they preferred oral intake of medications to subcutaneous injection (12.5%). in GR, 84.2% declared a preference for oral administration over subcutaneous injection (15.8%). in GF, a surprisingly high proportion of patients (73.3%; p < 0.001) declared that they preferred subcutaneous administration of medications over the oral route (26.7%). overall, the rate of compliance with antithrombotic drug therapy was very high, at 99%. Conclusions: intake of the noAs dabigatran and rivaroxaban following hospital discharge is entirely the responsibility of the patient; a high level of patient compliance with these drugs must therefore be demonstrated in order for them to become well accepted within the medical community. the results of this study showed a very high level of compliance both with orally and subcutaneously administered drugs. Level of evidence: Level i, randomized clinical study.

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Oral direct factor Xa inhibitor versus enoxaparin for thromboprophylaxis after hip or knee arthroplasty: Systemic review, traditional meta-analysis, dose–response meta-analysis and network meta-analysis

Cited by 56 publications

References 41 publications

Effectiveness and Tolerability of Anticoagulants for Thromboprophylaxis after Major Joint Surgery: a Network Meta-Analysis

Effectiveness and Tolerability of Anticoagulants for Thromboprophylaxis after Major Joint Surgery: a Network Meta-Analysis

Direct Oral Anticoagulants Vs. Enoxaparin for Prevention of Venous Thromboembolism Following Orthopedic Surgery: A Dose–Response Meta‐analysis

Patient compliance with new oral anticoagulants after major orthopaedic surgery: rivaroxaban and dabigatran compared with subcutaneous injection of fondaparinux

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