Wound complications and bleeding with new oral anticoagulants in patients undergoing total joint arthroplasty: A systematic review and meta‐analysis of randomized controlled trials

Abstract

Aims The results of associations between new oral anticoagulants (NOACs) and wound complications after total joint arthroplasty remain inconsistent. We conducted a systematic review and meta‐analysis of randomized controlled trials to make comparisons with low molecular weight heparins (LMWH) on the clinical outcomes of total wound complications, together with other efficacy and safety endpoints to further evaluate the safety and efficacy of NOACs. Methods This meta‐analysis was conducted based on a published protocol (PROSPERO: CRD42019140841). We searched for available articles in PubMed, Embase and Cochrane Library through Jun 62 021. Random‐effects meta‐analyses, including subgroup analyses, were conducted to estimate the pooled relative risk (RR) and 95% confidence interval (CI) for specific doses of NOACs. Results We retrieved 1683 studies, of which 20 were eligible for inclusion. We found that apixaban was associated with a lower incidence of total wound complications compared with LMWH (RR = 0.81; 95% CI: 0.65–1.00), while dabigatran and rivaroxaban did not increase the risk of total wound complications. In addition, apixaban was associated with a reduction in the risk of major/clinically relevant nonmajor bleeding events compared to LMWH (RR = 0.80, 95% CI: 0.65–0.99), while rivaroxaban increased the risk for major/clinically relevant nonmajor bleeding events (RR = 1.23, 95% CI: 1.02–1.50). Moreover, all 4 NOACs were associated with lower incidences of major venous thromboembolism compared with LMWH. Conclusion A lower risk of wound complications was detected for apixaban, while dabigatran and rivaroxaban did not increase the risk when compared with LMWH. The efficacy of 4 NOACs was broadly similar.

Recommendations from the ICM-VTE: General

“…Direct Thrombin Inhibitors: Direct thrombin inhibitors have also had inconsistent results in the literature. In a metaanalysis comparing dabigatran with LMWH and Factor Xa inhibitors, the authors found no difference with regard to wound complication rates 2105 . Gill et al, performed a prospective study comparing dabigatran and dalteparin, noting that the reoperation rate for wound complications in the dabigatran group was 7% compared to 1% in the dalteparin group 2106 .…”

Fondaparinux sodium and low molecular weight heparin for venous thromboembolism prophylaxis in Chinese patients with major orthopedic surgery or trauma: a real-world study

“…Comparison of outcomes between FPX group and LMWH group before IPTW (A) and after IPTW (B). IPTW, inverse-probability-of-treatment weighting method a reduction in the risk of major/clinically relevant nonmajor bleeding events compared to LMWH [18].…”