Why the study?
Prophylactic anticoagulation is recommended to reduce venous thromboembolism after total hip replacement, but it is unclear which anticoagulant is preferable.
Do new oral anticoagulants reduce venous thromboembolism or alter bleeding risk compared to enoxaparin in patients after total hip replacement?
Do new oral anticoagulants reduce venous thromboembolism or alter bleeding risk compared to enoxaparin in patients after total hip replacement?
New oral anticoagulants show comparable overall efficacy and safety to enoxaparin for VTE prevention after total hip replacement, though individual agents like rivaroxaban present specific trade-offs between VTE reduction and bleeding risk.
Rivaroxaban reduces VTE at the expense of more bleeding without net clinical gain versus enoxaparin; confirms agent-specific trade-offs rather than class effects in post-THR prophylaxis.
Prophylactic anticoagulant therapy is recommended for reducing the risk of venous thromboembolism (VTE) after a total hip replacement (THR). However, it is not clear which anticoagulant is preferable. Hence, a systematic review and meta-analysis of randomized double-blind controlled trials (RDBCTs) were conducted to investigate the clinical efficacy and safety of enoxaparin in comparison with newer oral anticoagulants for the prevention of VTE after THR. The Cochrane Library, Scopus, Web of Science, Embase, and PubMed/Medline databases were used for PICO search strategy. Relative risks (RR) of symptomatic VTE, clinically relevant bleeding, mortality, and a net clinical endpoint were estimated employing a random effect meta-analysis. ITC and RevMan software were used for indirect and direct comparisons, respectively. Nine RDBCTs comprising 24,584 patients were included. As compared to enoxaparin, a reduced risk for symptomatic VTE was observed with rivaroxaban (confidence interval [CI]: 0.32-0.77; RR: 0.46%) and comparable with apixaban (0.12-1.26; 0.42%) and dabigatran (0.22-2.20; 0.70%). Contrarily to enoxaparin, a greater risk for clinically relevant bleeding was observed with rivaroxaban (1.03-1.48; 1.23%), comparable with dabigatran (0.96-1.33; 1.10%) and reduced with apixaban (0.19-5.66; 0.96%). In indirect or direct comparisons, the interventions did not differ on the net clinical endpoint. In conclusion, the findings of this meta-analysis revealed no significant difference in the efficacy and safety of new oral anticoagulants as compared to enoxaparin for the prevention of VTE after total hip replacement surgery.
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Mohammed Alfarhan (2022) studied this question.
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