Key result
Enoxaparin shows ~5-fold greater efficacy than fondaparinux for preventing VTE in total knee arthroplasty.
Why the study?
Given the high risk of venous thromboembolism following orthopedic surgery, the authors sought to evaluate the efficacy and safety of post-major orthopedic surgery thromboprophylaxis regimens.
Do alternative thromboprophylaxis agents (fondaparinux, dabigatran, rivaroxaban, apixaban, aspirin) prevent VTEs and reduce adverse events compared to enoxaparin in patients undergoing major orthopedic surgery?
Meta-Analysis (n=48,424)
Yes
Do alternative thromboprophylaxis agents (fondaparinux, dabigatran, rivaroxaban, apixaban, aspirin) prevent VTEs and reduce adverse events compared to enoxaparin in patients undergoing major orthopedic surgery?
Answers are grounded in this paper and cite their sources.
In patients undergoing major orthopedic surgery, enoxaparin showed superior VTE prevention compared to fondaparinux (in TKA) and apixaban (in THA), while other agents were non-inferior regarding mortality and bleeding.
Given the high risk of venous thromboembolism (VTE) post-orthopedic surgery and the vital role of thromboprophylaxis in preventing VTEs, this meta-analysis aimed to assess the efficacy of thromboprophylaxis post major orthopedic surgery and the relevant safety measures. In this review, we conducted a computer-aided search of Google Scholar, PubMed, CINAHL, Cochrane, Medline, and EMBASE databases. We included all published randomized clinical trials (RCTs) that utilized enoxaparin, fondaparinux, dabigatran, rivaroxaban, apixaban, and aspirin for VTE prophylaxis in patients undergoing total hip arthroplasty (THA), hip fracture surgery, and total knee arthroplasty (TKA) based on primary and secondary outcomes. The Cochrane Collaboration tool was used to evaluate the risk of bias. All statistical analyses were performed using Review Manager Software. A total of 23 RCTs were included with a total sample of 48,424 patients and an overall low risk of bias. The efficacy of enoxaparin in preventing VTEs in the TKA group was significantly better than fondaparinux. In the THA group, the efficacy of enoxaparin was significantly better than apixaban. The efficacies of fondaparinux, dabigatran, rivaroxaban, apixaban, and aspirin were comparable to that of enoxaparin in reducing VTE-associated mortality, major bleeding, and adverse events. In conclusion, we found that all included drugs were non-inferior to enoxaparin in VTE-associated mortality, major bleeding, and adverse events.
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Alsheikh et al. (2021) conducted a meta-analysis in Major orthopedic surgery (THA, TKA, hip fracture surgery) (n=48,424). Thromboprophylaxis (enoxaparin, fondaparinux, dabigatran, rivaroxaban, apixaban, aspirin) vs. Active comparators (head-to-head) was evaluated on Venous thromboembolism (VTE) incidence (Z = 5.04, 95% CI 1.84-3.99, p=<0.00001). In patients undergoing total knee arthroplasty, enoxaparin demonstrated approximately five-fold higher efficacy in preventing venous thromboembolism compared to fondaparinux (p<0.00001).
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