Key result
Apixaban 2.5 mg twice daily started after total knee and hip replacement appears more effective for venous thromboembolism prevention than enoxaparin used in accordance with the European model, without increased bleeding.
Why the study?
Does apixaban improve the prevention of venous thromboembolism compared to enoxaparin in patients undergoing major elective orthopedic surgery?
Does apixaban improve the prevention of venous thromboembolism compared to enoxaparin in patients undergoing major elective orthopedic surgery?
This review summarizes the efficacy and safety of apixaban compared to enoxaparin for VTE prophylaxis in major orthopedic surgery.
May support apixaban for post-arthroplasty VTE prophylaxis; leaves open prospective validation vs European enoxaparin.
Despite current guidelines recommendations about anticoagulant prophylaxis, many studies have shown an high venous thromboembolism (VTE) incidence in patients undergoing total hip and knee arthroplasty. A number of anticoagulants are currently available, but they have some limitations that affect their applicability and consequently their effectiveness. Several new oral anticoagulants (NOACs) have been developed in an attempt to overcome these limitations. Apixaban is a NOAC that selectively inhibits the coagulation factor Xa; it is approved for the prevention of VTE after total hip replacement and total knee replacement surgery. This review examines the results of main trials designed to test efficacy and safety of apixaban in major elective orthopedic surgery.
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Maniscalco et al. (2014) conducted a review in Elective Major Orthopedic Surgery (Total Hip and Knee Arthroplasty) (n=13,310). Apixaban vs. Enoxaparin (30 mg twice daily or 40 mg once daily) was evaluated on Venous thromboembolism (VTE) and all-cause mortality. Apixaban 2.5 mg twice daily started after total knee and hip replacement appears more effective for venous thromboembolism prevention than enoxaparin used in accordance with the European model, without increased bleeding.
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