A Prospective Cohort Comparative Study of Rivaroxaban, Dabigatran, and Apixaban Oral Thromboprophylaxis in 2431 Hip and Knee Arthroplasty Patients: Primary Efficacy Outcomes and Safety Profile

Highcock, Alan J.; As-Sultany, Mohammed; Finley, Rosemary; Donnachie, N.J.

doi:10.1016/j.arth.2020.06.032

Cited by 18 publications

(11 citation statements)

References 33 publications

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“…Another cohort study by Alan et al compared the efficacy of three DOAC drugs, with superior results for rivaroxaban versus dabigatran with apixaban obtained for the prevention of VTE, with p < 0.01 for comparison of both. Thus, they found rivaroxaban to be superior to the other two drugs for the prevention of VTE [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…Other cohort studies that support these findings, such as Loganathan et al, found that there was no significant difference between the rivaroxaban group and LMWHs for the parameters of nonmajor bleeding and major bleeding. [ 24 ] Another cohort study by Alan et al showed that rivaroxaban had the same bleeding risk as apixaban and dabigatran, which was around 1.3%; i.e., there were no significant differences between them [ 27 ]. Another RCT study by Alok et al compared the use of rivaroxaban and a placebo in high-risk ambulatory cancer patients [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the Efficacy and Safety of Rivaroxaban and Enoxaparin as Thromboprophylaxis Agents for Orthopedic Surgery—Systematic Review and Meta-Analysis

Rinaldi

Amin

Shufiyani

et al. 2022

JCM

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Venous thromboembolism (VTE) is a serious complication that can occur during and after postoperative treatment, including in treatment after orthopedic surgery. The current guidelines for VTE prophylaxis in postoperative patients recommend the use of LMWHs, one of which is enoxaparin. Another recommendation for use in pharmacological VTE prophylaxis is rivaroxaban, which has better efficacy than enoxaparin but a higher bleeding risk. The aim of this systematic review is to provide an update on the profile of rivaroxaban for VTE prophylaxis after orthopedic surgery. PubMed, SCOPUS, EMBASE, and EBSCOhost were searched up until May 2022. The outcome sought was efficacy and safety, described by the incidence of VTE and incidence of bleeding, respectively. Five randomized controlled trials (RCT) were finally included. Rivaroxaban was confirmed to have better efficacy by significantly reducing the risk of VTE and all-cause mortality (RR = 0.38; 95% CI = 0.27–0.54) compared to enoxaparin. However, regarding the safety variable, no significant difference was found between the incidence of major bleeding in rivaroxaban and enoxaparin (RR = 0.97; 95% CI = 0.56–1.68). The results of the analysis show that rivaroxaban has better efficacy than enoxaparin but the same safety profile, so when used, the bleeding of patients should still be monitored.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of the Efficacy and Safety of Rivaroxaban and Enoxaparin as Thromboprophylaxis Agents for Orthopedic Surgery—Systematic Review and Meta-Analysis

Rinaldi

Amin

Shufiyani

et al. 2022

JCM

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“…While awaiting the results from direct comparative ("head to head") clinical trials, indirect comparisons, and cohort trials indicate that differences might exist. In the recent, first prospective cohort comparative study on efficacy and safety of 3 DOACs (rivaroxaban, dabigatran, and apixaban) in 2431 hip/knee arthroplasty patients (16) the authors suggested that rivaroxaban may have superior efficacy over apixaban and dabigatran while no difference was observed in major bleeding incidence among these agents. ASH (2018) guidelines for VTE prophylaxis in acutely ill medical patients recommend LMWH over DOAC for VTE prophylaxis (9).…”

Section: Risk Factor Pointsmentioning

confidence: 99%

The current place of direct oral anticoagulants in the prevention/treatment of venous thromboembolism

Tomić¹

2020

Arhiv za farmaciju

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Venous thromboembolism (VTE; includes deep venous thrombosis, DVT, and pulmonary embolism, PE) represents the third most common acute cardiovascular syndrome. Contemporary VTE management comprises primary prevention in high-risk patients, treatment of established VTE, and prevention of its recurrence (secondary prevention). Anticoagulants are the basis of VTE pharmacological prophylaxis and treatment. For several decades, parenteral (heparin and low-molecular-weight heparins, LMWHs) and oral anticoagulants (vitamin K antagonists, VKAs) have been the cornerstone of VTE prevention/treatment. The introduction of direct oral anticoagulants (DOACs: thrombin inhibitor dabigatran and Xa inhibitors rivaroxaban, apixaban, edoxaban, and betrixaban) markedly improved the management of VTE by overcoming many disadvantages of conventional anticoagulants. For primary VTE prevention in patients after total hip/knee arthroplasty, rivaroxaban, apixaban, and dabigatran are preferred over LMWHs, due to comparable efficacy and safety, but favourable acceptability (avoided everyday injections). In other high-risk populations (other surgical patients, acutely ill medical patients), LMWHs are still the recommended option. Betrixaban is currently the only DOAC approved for VTE prophylaxis in medically ill patients during and after hospitalization. For acute VTE treatment and secondary prevention, DOACs (rivaroxaban, apixaban, edoxaban, and dabigatran) are recommended as the first-line therapy in the general population. DOACs proved to be similarly effective but safer than VKAs. In some specific populations, DOACs also seem to be advantageous over conventional treatment (patients with renal impairment, elderly, long-term secondary prevention in cancer patients). Currently, there is no data from randomized head-to-head comparative studies between the DOAC classes or representatives so the choice is made mainly according to patient characteristics and pharmacokinetic properties of the drug.

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“…Several new oral anticoagulant drugs have been developed in recent years, such as apixaban, a direct factor Xa inhibitor that also inhibits the conversion of prothrombin to thrombin and thereby thrombus formation. 8,9 The main advantage of apixaban is that it is administered orally, thus allowing it to be prescribed outside of hospitals and negating the need for its regular laboratory monitoring.…”

mentioning

confidence: 99%

Effectiveness of apixaban versus enoxaparin in preventing wound complications and deep venous thrombosis following total knee replacement surgery: A retrospective study

2021

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Deep venous thrombosis (DVT), which is the formation of a blood clot (thrombus) in the veins, is a life-threatening condition caused mainly by vascular injuries, immobility, and hypercoagulation. 1 It can complicate the outcomes of patients who have undergone orthopaedic surgeries, such as for a total knee replacement or total hip replacement, especially in elderly patients who are more prone to long periods of immobility after surgery and injury. 2,3 Falck-Ytter et al 4 estimated a 5%-22% DVT incidence following total knee replacement surgery owing to the increasing numbers of such surgeries and the advanced age of the patients. Fortunately, DVT is a preventable complication, and many guidelines have been suggested to lower its incidence. 5 The prevention of DVT following orthopaedic surgery is based significantly on pharmacological prophylactic treatments, such as anticoagulant drugs, the most commonly used one of which is low-molecular-weight heparin (enoxaparin). 6 Enoxaparin indirectly

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A Prospective Cohort Comparative Study of Rivaroxaban, Dabigatran, and Apixaban Oral Thromboprophylaxis in 2431 Hip and Knee Arthroplasty Patients: Primary Efficacy Outcomes and Safety Profile

Cited by 18 publications

References 33 publications

Comparison of the Efficacy and Safety of Rivaroxaban and Enoxaparin as Thromboprophylaxis Agents for Orthopedic Surgery—Systematic Review and Meta-Analysis

Comparison of the Efficacy and Safety of Rivaroxaban and Enoxaparin as Thromboprophylaxis Agents for Orthopedic Surgery—Systematic Review and Meta-Analysis

The current place of direct oral anticoagulants in the prevention/treatment of venous thromboembolism

Effectiveness of apixaban versus enoxaparin in preventing wound complications and deep venous thrombosis following total knee replacement surgery: A retrospective study

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