What question did this study set out to answer?

To systematically compare the efficacy and safety of apixaban versus enoxaparin for thromboprophylaxis in patients undergoing total knee arthroplasty.

October 12, 2010Thrombosis and Haemostasis

Apixaban versus enoxaparin in patients with total knee arthroplasty

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Why the study?

Does apixaban reduce major VTE and bleeding compared to enoxaparin in patients following total knee arthroplasty?

Key Points

To systematically compare the efficacy and safety of apixaban versus enoxaparin for thromboprophylaxis in patients undergoing total knee arthroplasty.
Conducted a systematic search of Medline, EMBASE, and Cochrane Central Register of Controlled Trials for prospective randomized controlled trials comparing apixaban to enoxaparin post-TKA.
Identified and meta-analyzed 3 RCTs comprising 7,337 patients receiving either apixaban 2.5 mg once daily (n=4,057) or subcutaneous enoxaparin (n=3,280; 40 mg once-daily or 30 mg twice-daily).
Apixaban versus enoxaparin yielded odds ratios for major venous thromboembolism of 0.47 (95% CI: 0.27 to 0.82; 0.6% vs. 1.2%) and 2.09 (95% CI: 0.99 to 4.45; 0.6% vs. 0.3%) across evaluated comparisons.
Apixaban treatment demonstrated a significant reduction in major bleeding rates compared to enoxaparin (OR=0.55; 95% CI: 0.32 to 0.96).
All-cause mortality was 0.2% in the apixaban arm versus 0.09% in the enoxaparin arm (OR=1.74; 95% CI: 0.51 to 5.95), with no significant differences observed in non-major bleeding, hepatic enzymes, or arterial events.

Structured PICO

Does apixaban reduce major VTE and bleeding compared to enoxaparin in patients following total knee arthroplasty?

Population

3 RCTs involving 7,337 patients following total knee arthroplasty (TKA) who have a high risk of venous thromboembolism (VTE)

Intervention

Apixaban 2.5 mg once daily

Comparator

Subcutaneous enoxaparin (40 mg once-daily or 30 mg twice-daily)

Outcome

Composite of major VTE (proximal deep-vein thrombosis and pulmonary embolism)composite

Apixaban is non-inferior to enoxaparin for VTE prevention after total knee arthroplasty and offers a superior safety profile regarding major bleeding.

Discussion

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Implication

Apixaban may be preferred over enoxaparin for post-TKA VTE prophylaxis; confirms superior efficacy and safety in meta-analysis.

Cite This Study

Huang et al. (2010) studied this question.

synapsesocial.com/papers/6a73f703bbad068246a8c799 https://doi.org/10.1160/th10-08-0552

Topics

Anticoagulation in AF

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Apixaban versus enoxaparin in patients with total knee arthroplasty

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Topics

Apixaban versus enoxaparin in patients with total knee arthroplasty

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider