Edoxaban 30 mg once daily significantly reduced the incidence of venous thromboembolism compared to enoxaparin 20 mg twice daily (5.1% vs 10.7%, P<0.001) following total knee or hip arthroplasty, with comparable bleeding rates.
RCT (n=1,326)
Double-blind
Randomized
Yes
Does edoxaban reduce the incidence of venous thromboembolism compared to enoxaparin in patients undergoing total knee or hip arthroplasty?
In a pooled analysis of two phase 3 trials, edoxaban 30 mg once daily significantly reduced the incidence of VTE and coagulation biomarkers compared to enoxaparin 20 mg twice daily following total knee or hip arthroplasty, with comparable bleeding rates.
Absolute Event Rate: 5.1% vs 10.7%
p-value: p=<0.001
The objective of this analysis was to assess the effects of edoxaban compared with enoxaparin on key coagulation biomarkers and present pooled primary efficacy and safety results from phase 3 STARS E-3 and STARS J-V trials for prevention of venous thromboembolism (VTE) after total knee arthroplasty (TKA) or total hip arthroplasty (THA). In the randomized, double-blind, double-dummy, multicenter, STARS E-3 and STARS J-V trials, patients received edoxaban 30 mg or enoxaparin 2000 IU (20 mg) twice daily for 11 to 14 days. The studies were conducted in Japan and Taiwan; enoxaparin dosing was based on Japanese label recommendations. The primary efficacy endpoint was incidence of VTE; the safety endpoint was major or clinically relevant nonmajor (CRNM) bleeding. Blood samples were taken at presurgical evaluation, pretreatment (postsurgery), predose on day 7, predose on completion of treatment, and at a follow-up examination 25 to 35 days after the last dose of study drug for D-dimer, prothrombin fragment 1 + 2 (F1+2), and soluble fibrin monomer complex (SFMC) measurement. A total of 716 patients enrolled in STARS E-3 and 610 patients enrolled in STARS J-V; 1326 patients overall. This analysis included 657 patients who received edoxaban 30 mg QD and 650 patients who received enoxaparin 20 mg BID. Incidence of VTE was 5.1 and 10.7% for edoxaban and enoxaparin, respectively (P <0.001). Incidence of combined major and CRNM bleeding was 4.6 and 3.7% for edoxaban and enoxaparin, respectively (P = 0.427). On day 7, mean D-dimer (4.4 vs 5.5 μg/mL), F1+2 (363 vs 463 pmol/L), and SFMC (5.7 vs 6.8 μg/mL) were lower in edoxaban-treated patients relative to enoxaparin-treated patients, respectively (P <0.0001 for all). At end of treatment, mean D-dimer (5.4 vs 6.2 μg/mL), F1+2 (292 vs 380 pmol/L), and SFMC (6.2 vs 7.2 μg/mL) were lower in edoxaban-treated patients relative to enoxaparin-treated patients (P <0.0001 for all). Edoxaban was superior to enoxaparin in prevention of VTE following TKA and THA, with comparable rates of bleeding events. Relative to enoxaparin, edoxaban significantly reduced D-dimer, F1+2, and SFMC. Clintrials.gov NCT01181102 and NCT01181167 . Both registered 8/12/2010.
Kawai et al. (2016) conducted an RCT in Venous thromboembolism prevention after total knee or hip arthroplasty (n=1,326). Edoxaban vs. Enoxaparin 20 mg twice daily was evaluated on Incidence of venous thromboembolism (composite of asymptomatic DVT and symptomatic DVT or PE) (p=<0.001). Edoxaban 30 mg once daily significantly reduced the incidence of venous thromboembolism compared to enoxaparin 20 mg twice daily (5.1% vs 10.7%, P<0.001) following total knee or hip arthroplasty, with comparable bleeding rates.