Apixaban versus enoxaparin in the prevention of venous thromboembolism following total knee arthroplasty: a single‐centre, single‐surgeon, retrospective analysis

King, Danika A. L.; Pow, R E; Dickison, David; Vale, Peter R.

doi:10.1111/imj.13139

Cited by 6 publications

(9 citation statements)

References 46 publications

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“…Given reports of high VTE rates in Australia [3], VTE pharmacoprophylaxis has remained as the main focus of clinical interest. Recent studies have indicated VTE rates in Australia range from 0.7% (in-hospital) to 4.7%, [26, 27] almost comparable to the rates of bleeding (1.5–6.7%) [27, 28]. Although the generalisability of these figures remains uncertain, it does speak to the issue raised by Campbell et al that bleeding and adverse events were seemingly under-emphasised in pharmacoprophylaxis studies [29].…”

Section: Discussionmentioning

confidence: 99%

A comparative cost-effectiveness analysis of mechanical and pharmacological VTE prophylaxis after lower limb arthroplasty in Australia

Torres

Saunders

2019

J Orthop Surg Res

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Background Venous thromboembolism (VTE) is a complication following surgery. Low-molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs) are efficacious but come with inherent bleeding risk. Mechanical prophylaxis, such as intermittent pneumatic compression (IPC), does not induce bleeding but may be difficult to implement beyond the immediate post-operative period. This study compared the cost and quality-adjusted life years (QALYs) saved of commonly used VTE prophylaxis regimens after lower limb arthroplasty. Methods A previously published cost-utility model considering major efficacy and safety endpoints was updated to estimate the 1-year cost-effectiveness of different VTE prophylaxis regimens. The VTE strategies assessed included apixaban, dabigatran, rivaroxaban, LMWH, IPC, IPC + LMWH and IPC + apixaban. Efficacy data were derived from studies in PubMed, and cost data came from the 2017 Australian AR-DRG and PBS pricing schemes. Results Costs for VTE prophylaxis including treatment of its associated complications over the first year after surgery ranged from AUD $644 (IPC) to AUD $956 (rivaroxaban). Across 500 simulations, IPC was the cheapest measure in 73% of simulations. In 97% of simulations, a DOAC was associated with the highest resulting QALYs. Compared to IPC, apixaban was cost-effective in 76.4% of simulations and apixaban + IPC in 87.8% of simulations. For VTE events avoided, the DOACs and IPC were on par. LMWH and LMWH + IPC were negatively dominated. Conclusions Apixaban, IPC or a sequential/simultaneous combination of both is currently the most cost-effective VTE prophylaxis regimens. The choice between them is best guided by the relative VTE and bleeding risks of individual patients.

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Section: Discussionmentioning

confidence: 99%

A comparative cost-effectiveness analysis of mechanical and pharmacological VTE prophylaxis after lower limb arthroplasty in Australia

Torres

Saunders

2019

J Orthop Surg Res

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“…In three of the included studies, direct thrombin-and factor Xa inhibitors were used as thromboprophylaxis, including dabigatran, 17 rivaroxaban, 18 and apixaban. 19 In patients receiving dabigatran, the risk within 90 days of hospital admission was 0.2% (THA) to 1.1% (TKA) for DVT, 0.4% (TKA) to 0.5% (THA) for PE, and 0% for death. 17 The dabigatran dose was 110 mg four hours following surgery, and then 220 mg daily for 28 days (THA) or 14 days (TKA).…”

Section: Direct Thrombin-and Factor Xa Inhibitorsmentioning

confidence: 92%

“…The main variables for each study are shown in Table 1, and include the following specific prophylactic agents: 1) warfarin [10][11][12] ; 2) low molecular weight heparins (LMWHs) (enoxaparin, dalteparin, and nadroparin) [13][14][15][16][17] ; 3) unfractionated heparin 13 ; 4) direct thrombin-and factor Xa inhibitors (dabigatran, rivaroxaban, and apixaban) [17][18][19] ; 5) acetylsalicylic acid 11,12,14,20,21 ; and 6) fondaparinux. 13 Below, we summarize the findings presented in Table 1.…”

Section: Included Studiesmentioning

confidence: 99%

Real-world effectiveness and safety of pharmacological thromboprophylaxis in patients undergoing primary total hip and knee arthroplasty: A narrative review

Schelde

Eliasen

Olesen

et al. 2020

Journal of Orthopaedics

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In this narrative review of the real-world effectiveness and safety of pharmacological thromboprophylaxis following primary total hip and knee arthroplasty, a total of 12 non-interventional observational studies were included. Pharmacological thromboprophylaxis included warfarin, heparins, dabigatran, rivaroxaban, apixaban, acetylsalicylic acid, and fondaparinux. The absolute risks varied across the included studies. These variations can be explained by differences in patient populations, drug exposure, follow-up time, and definition of outcomes, which makes it a challenge to compare the risk estimates. These findings emphasize the need for a large population-based real-world study to provide comparable risk estimates associated with different pharmacological thromboprophylaxis.

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“…In recent years, new anticoagulant oral preparations have been developed. Apixaban is a new potent oral FXa inhibitor that can rapidly combine with FXa and transform prothrombin into thrombin 89. One study has shown that apixaban can significantly reduce the incidence of DVT and the associated mortality after orthopedic surgery 10.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Apixaban and Low Molecular Weight Heparin in Preventing Deep Venous Thrombosis after Total Knee Arthroplasty in Older Adults

et al. 2019

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Purpose To compare the effect of apixaban and low molecular weight heparin (LMWH) in the prevention and treatment of deep venous thrombosis (DVT) after total knee arthroplasty in older adult patients. Materials and Methods A total of 220 patients (average age of 67.8±6.4 years) undergoing total knee arthroplasty were randomly selected as research subjects and were divided into apixaban and LMWH groups (110 in each group). Results The incidence of DVT was lower in the apixaban group than in the LMWH group (5.5% vs. 20.0%, p =0.001). Activated partial thromboplastin times (35.2±3.6 sec vs. 33.7±2.2 sec, p =0.010; 37.8±4.6 sec vs. 34.1±3.2 sec, p <0.001; 39.6±5.1 sec vs. 35.7±3.0 sec, p =0.032) and prothrombin times (14.0±1.0 sec vs. 12.8±0.9 sec, p <0.001; 14.5±1.2 sec vs. 13.0±1.1 sec, p <0.001; 15.3±1.4 sec vs. 13.2±1.3 sec, p =0.009) in the apixaban group at 1 week after surgery, 3 weeks after surgery, and the end of treatment were higher than those in the LMWH group. Platelet and fibrinogen levels in the apixaban group were lower than those of the LMWH group. Also, capillary plasma viscosity and erythrocyte aggregation in the apixaban group at 1 week after surgery, 3 weeks after surgery, and the end of treatment were lower than those in the LMWH group. Conclusion Apixaban, which elicits fewer adverse reactions and is safer than LMWH, exhibited better effects in the prevention and treatment of DVT after total knee arthroplasty in older adults.

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Apixaban versus enoxaparin in the prevention of venous thromboembolism following total knee arthroplasty: a single‐centre, single‐surgeon, retrospective analysis

Abstract: Compared with enoxaparin, thromboprophylaxis with apixaban resulted in a lower VTE incidence and fewer haemorrhagic complications.

Cited by 6 publications

References 46 publications

A comparative cost-effectiveness analysis of mechanical and pharmacological VTE prophylaxis after lower limb arthroplasty in Australia

A comparative cost-effectiveness analysis of mechanical and pharmacological VTE prophylaxis after lower limb arthroplasty in Australia

Real-world effectiveness and safety of pharmacological thromboprophylaxis in patients undergoing primary total hip and knee arthroplasty: A narrative review

Comparison of Apixaban and Low Molecular Weight Heparin in Preventing Deep Venous Thrombosis after Total Knee Arthroplasty in Older Adults

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