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Anticoagulants for the Prevention of VTE After Arthroplasty

by U.S. Medicine

January 21, 2017

ST LOUIS—Because venous thromboembolism (VTE) is a common and potentially fatal complication of arthroplasty, a recent meta-analysis looked at the safety and effectiveness of new anticoagulants for the prevention of VTE after hip and knee procedures.

The study, published in the Journal of Arthroplasty, was based on a review of randomized trials to determine which anticoagulant has the best safety and efficacy in hip and knee arthroplasty patients.1

A study team led by researchers from Washington University in St. Louis and the VA San Diego Healthcare System’s Department of Pharmacy searched PubMed, MEDLINE, and EMBASE through January 2016 for pertinent trials.

Results indicate that, compared to enoxaparin, which is most commonly dosed at 40 mg once daily, the relative risk (RR) of VTE was lowest for edoxaban dosed at 30 mg once daily, which has an RR of 0.49; fondaparinux 2.5 mg once daily, RR 0.53; and rivaroxaban 10 mg once daily, RR 0.55.

At the same time, the relative risk of major/clinically relevant bleeding was lowest for apixaban 2.5 mg twice daily, RR 0.84; and highest for rivaroxaban, with an RR of 1.27, and fondaparinux, with an RR of1.64; 95%.

The report notes that fondaparinux was the only agent that was more effective than enoxaparin 30 mg twice daily, with a relative VTE risk of 0.58.

“With the possible exception of apixaban, newer anticoagulants that lower the risk of postoperative VTE increase bleeding,” study authors conclude.

  1. Venker BT, Ganti BR, Lin H, Lee ED, Nunley RM, Gage BF. Safety and Efficacy of New Anticoagulants for the Prevention of Venous Thromboembolism After Hip and Knee Arthroplasty: A Meta-Analysis. J Arthroplasty. 2016 Oct 5. pii: S0883-5403(16)30678-7. doi: 10.1016/j.arth.2016.09.033. [Epub ahead of print] PubMed PMID: 27823844.

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