Key result
Apixaban reduces major bleeding ~44% vs. enoxaparin after knee arthroplasty, while rivaroxaban shows no difference.
Why the study?
Direct experimental safety comparisons of apixaban and rivaroxaban on their approved therapeutic indications were not identified, prompting a meta-analysis to better evaluate their safety profiles.
Do apixaban and rivaroxaban improve safety (reduce bleeding) compared to enoxaparin in patients after hip and knee arthroplasty?
Population
Patients undergoing hip and knee arthroplasty from 12 clinical trials
Comparison
Apixaban and rivaroxaban versus enoxaparin
Design
Meta-analysis of clinical trials
Authors
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Apixaban may be prioritized over enoxaparin for knee arthroplasty prophylaxis; extends evidence of differential NOAC bleeding safety versus LMWH.
Meta-Analysis
Do apixaban and rivaroxaban improve safety (reduce bleeding) compared to enoxaparin in patients after hip and knee arthroplasty?
Relative Risk: 0.56 (95% CI 0.32–0.96)
Apixaban appears to have a more favorable bleeding profile than enoxaparin following total knee arthroplasty, a benefit not observed with rivaroxaban or after hip arthroplasty.
Alves et al. (2011) conducted a meta-analysis in Hip and Knee Arthroplasty. Apixaban and Rivaroxaban vs. Enoxaparin was evaluated on Major bleeding (RR 0.56, 95% CI 0.32-0.96). Apixaban was associated with significantly fewer major bleeding events compared to enoxaparin after knee arthroplasty (RR 0.56; 95% CI 0.32-0.96), whereas rivaroxaban showed no significant difference.
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