Brett T Venker1, Beejal R Ganti2, Hannah Lin3, Elizabeth D Lee4, Ryan M Nunley5, Brian F Gage6. 1. Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri; Department of Pharmacy, Veterans Affairs San Diego Healthcare System, San Diego, California. 2. Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri; Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan. 3. Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri; University of Massachusetts Medical School, Worcester, Massachusetts. 4. Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri; Carolina Rehabilitation and Surgical Associates, Raleigh, North Carolina. 5. Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri; Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri. 6. Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri.
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.
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 arthroplastypatients. 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.
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