Why the study?
Does apixaban reduce VTE and all-cause death compared to other anticoagulants in patients following elective knee or hip replacement?
Does apixaban reduce VTE and all-cause death compared to other anticoagulants in patients following elective knee or hip replacement?
Apixaban demonstrates superior efficacy to dabigatran and similar efficacy to rivaroxaban for VTE prophylaxis after hip or knee replacement, with comparable bleeding risks.
Apixaban may be preferred over dabigatran for post-THR/TKR VTE prophylaxis; extends comparative NOAC efficacy data.
The present systematic review was conducted to assess the efficacy and safety of apixaban versus other anticoagulants, for the prevention of venous thromboembolism (VTE) following total hip replacement (THR) and total knee replacement (TKR) surgery. Electronic databases were interrogated to identify relevant randomized controlled trials. A series of direct/indirect comparisons and a network meta-analysis were conducted. Indirect comparisons found that the odds ratio of "all VTE and all-cause death" were significantly higher for dabigatran than for apixaban in patients with THR (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.50-4.21) and TKR (OR, 1.72; 95% CI, 1.22-2.42). Rivaroxaban showed similar efficacy to apixaban in patients with THR and TKR (OR, 0.69; 95% CI, 0.38-1.25 and OR, 0.83; 95% CI, 0.57-1.19, respectively). No significant differences were observed in bleeding outcomes between treatments. The novel anticoagulants apixaban, rivaroxaban, and dabigatran demonstrated similar or improved efficacy and similar safety compared with current therapies in this indication.
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Cohen et al. (2012) studied this question.
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