Why the study?
Do oral anticoagulants (dabigatran, apixaban, and rivaroxaban) reduce VTE and related complications in patients undergoing major orthopedic surgery compared to low-molecular-weight heparins?
Do oral anticoagulants (dabigatran, apixaban, and rivaroxaban) reduce VTE and related complications in patients undergoing major orthopedic surgery compared to low-molecular-weight heparins?
In patients undergoing major orthopedic surgery, rivaroxaban and apixaban offer better efficacy than dabigatran for VTE prophylaxis, though rivaroxaban carries a higher bleeding risk than apixaban.
Apixaban may be preferred over rivaroxaban for orthopedic VTE prophylaxis due to lower bleeding risk; extends comparative efficacy-safety data among DOACs.
EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Recognize the high risk of postoperative venous thromboembolism (VTE) in patients undergoing major orthopedic surgery. 2. Distinguish the different pharmacological mechanisms of VTE prophylaxis drugs. 3. Delineate the advantages and disadvantages of each VTE prophylaxis drug. 4. Recognize that rivaroxaban is as efficacious as apixaban but can increase the risk of hemorrhage. Patients undergoing major orthopedic surgery are at high risk for developing postoperative venous thromboembolism (VTE). The authors analyzed the available evidence on the efficacy and safety of dabigatran, apixaban, and rivaroxaban vs low-molecular-weight heparins (LMWHs) as VTE prophylaxis in major orthopedic surgery. Outcomes evaluated included total VTE, deep venous thrombosis (DVT), pulmonary embolism (PE), death, and major bleeding. Rivaroxaban and apixaban are more efficacious than dabigatran and are as safe as dabigatran. Rivaroxaban is as efficacious as apixaban but can increase the risk of hemorrhage.
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Cui et al. (2014) studied this question.
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