Oral anticoagulants (rivaroxaban and dabigatran) vs. enoxaparin in hip and knee arthroplasty: Systematic review and meta-analysis
Keywords:
Anticoagulants, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, KneeAbstract
Introduction: Hip and knee arthroplasty have risk of thromboembolic events and need prophylactic treatment to prevent it. Oral anticoagulants (Rivaroxaban and Dabigatran) may be better than the current gold standard (Enoxaparin) to prevent thromboembolic events.
Methods: A systematic review of the literature was done in Pubmed, Embase and Cochrane. Eligibility criteria were applied and data was extracted from the relevant trials. A meta-analysis was made with the data.
Results: Seven trials that fulfilled the eligibility criteria were found. The meta-analysis showed the following pooled information in relation to the comparison between Rivaroxaban and Dabigatran with enoxaparin for each outcome: death (OR 0.7, 95% CI 0.3-1.9 vs. OR 3.1, 95% CI 0.6-15.2), pulmonary embolism (OR 0.5, 95% CI 0.2-1.2 vs. OR 1.3, 95% CI 0.5-3.0), venous thromboembolism (OR 0.3, 95% CI 0.1-0.8 vs. OR 3.1, 95% CI 0.6-15.2), deep vein thrombosis (OR 0.5, 95% CI 0.3-1.8 vs. OR 1.0, 95% CI 0.8-1.4), major bleeding (OR 1.9, 95% CI 1.0-3.9 vs. OR 0.7, 95% CI 0.7-1.7) and minor bleeding (OR 1.1, 95% CI 0.9-1.2 vs. OR 1.2, 95% CI 0.9-1.5).
Discussion: Rivaroxaban is superior to Enoxaparin with a statistically significant difference for pulmonary embolism and deep vein thrombosis prophylaxis.
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References
1. Vaccaro AR. Orthopaedic knowledge update. Rosemont, IL, USA: American Academy of Orthopaedic Surgeons; 2005.
2. Moseley JB, O’Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002; 347(2): 81-8.
3. 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: 381S-453S.
4. Haas SB, Barrack RL, Westrich G, Lachiewicz RL. Venous thromboembolic disease after total hip and knee arthroplasty. J Bone Joint Surg Am 2008; 90: 2764-80.
5. Johanson NA, Lachiewicz PF, Lieberman JR, Lotke PA, Parvizi J, Pellegrini V, Stringer TA, Tornetta III P, Haralson RH, Watters WC. AAOS clinical practice guideline summary: prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty. J Am Acad Orthop Surg 2009; 17: 183-96.
6. Anderson FA, Wheeler HB, Goldberg RJ, Hosmer DW, Forcier A. The prevalence of risk factors for venous thromboembolism among hospital patients. Arch Intern Med 1992; 152: 1660-4.
7. Kakkar VV. Low dose heparin in the prevention of venous thromboembolism, rationale and results. Thromb Diath Haemorrh 1975; 33(1): 87-96.
8. Bergqvist D, Benoni G, Björgell O, Fredin H, Hedlundh U, Nicolas S, et al. Low-molecular-weight heparin (enoxaparin) as prophylaxis against venous thromboembolism after total hip replacement. N Engl J Med 1996; 335: 696-700.
9. Fauci AS, Braunwald E, Kasper DL, Hauser SL. Harrison’s principles of internal medicine. New York: McGraw-Hill Medical; 2008.
10. Eriksson BI, Borris LC, Friedman RJ, Haas S, Huisman MV, Kakkar AK, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after hip arthroplasty. N Engl J Med 2008; 358(26): 2765-75.
11. Kakkar AK, Brenner B, Dahl OE, Eriksson BI, Mouret P, Muntz J, et al. Extended duration rivaroxaban versus short-term enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a double-blind, randomised controlled trial. Lancet 2008; 372(9632): 31-9.
12. Lassen MR, Ageno W, Borris LC, Lieberman JR, Rosencher N, Bandel TJ, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty. N Engl J Med 2008; 358(26): 2776-86.
13. Turpie AG, Lassen MR, Davidson BL, Bauer KA, Gent M, Kwong LM, et al. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet 2009; 373(9676): 1673-80.
14. Ginsberg JS, Davidson BL, Comp PC, Francis CW, Friedman RJ, Huo MH, et al. Oral thrombin inhibitor dabigatran etexilate vs North American enoxaparin regimen for prevention of venous thromboembolism after knee arthroplasty surgery. J Arthroplasty 2009; 24(1): 1-9.
15. Eriksson BI, Dahl OE, Rosencher N, Kurth AA, van Dijk CN, Frostick SP, et al. Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J Thromb Haemost 2007; 5(11): 2178-85.
16. Kanan PS, Schwartsmann CR, Boschin LC, Conrad S, Silva MF. Comparative study between rivaroxaban and enoxaparin in deep venous thromboembolism prophylaxis in patients submitted to total hip arthroplasty. Rev Bras Ortop 2008; 43(8): 319-28.
17. Eriksson BI, Dahl OE, Ahnfelt L, Kalebo P, Stangier J, Nehmiz G, et al. Dose escalating safety study of a new oral direct thrombin inhibitor, dabigatran etexilate, in patients undergoing total hip replacement: BISTRO I. J Thromb Haemost 2004; 2(9): 1573-80.
18. Eriksson BI, Dahl OE, Büller HR, Hettiarachchi R, Rosencher N, Bravo ML, et al. A new oral direct thrombin inhibitor, dabigatranetexilate, compared with enoxaparin for prevention of thromboembolic events following total hip or knee replacement: the BISTRO II randomized trial. J Thromb Haemost 2005; 3(1): 103-11.
19. Eriksson BI, Dahl OE, Rosencher N, Kurth AA, Niek van Dijk C, Frostick SP, et al. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, non-inferiority trial. Lancet 2007; 370: 949-5.
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