Retrospective comparison of three thromboprophylaxis agents, edoxaban, fondaparinux, and enoxaparin, for preventing venous thromboembolism in total knee arthroplasty

Abstract

Purpose Patients undergoing total knee arthroplasty (TKA) are at high risk of venous thromboembolism, manifesting as deep vein thrombosis (DVT) or pulmonary embolism. The purpose of this study is to evaluate the efficacy and safety of edoxaban 15 mg once daily (o.d.) for preventing DVT in patients undergoing TKA. Methods Three hundred patients undergoing primary TKA under general anaesthesia for osteoarthritis were enrolled in this study: 100 treated with enoxaparin 2,000 IU twice daily (b.i.d.), 100 treated with fondaparinux 1.5 mg o.d. and 100 treated with edoxaban 15 mg o.d.. All treatments were scheduled to continue for 14 days. Results The incidence of DVT in patients treated with edoxaban 15 mg o.d. was lower than in patients with enoxaparin 2,000 IU b.i.d. and fondaparinux 1.5 mg o.d.. Ddimer levels were significantly lower in patients with edoxaban than in patients with enoxaparin and fondaparinux 1.5 mg o.d. on the first postoperative day; ΔHb levels were lower in patients with edoxaban than in patients with enoxaparin and fondaparinux on postoperative days, However, the difference was not statistically significant. Finally, the incidence of hepatic dysfunction was lower in patients with edoxaban than in patients with enoxaparin and fondaparinux. Conclusions Edoxaban 15 mg o.d. was more efficient than enoxaparin 2,000 IU b.i.d. and fondaparinux 1.5 mg o.d.. Furthermore, edoxaban was safe compared with enoxaparin and fondaparinux. Edoxaban, an orally administered direct factor Xa (FXa) inhibitor, may offer a new option for preventing DVT, with a level of evidence III.

The influence of a half-course tourniquet strategy on peri-operative blood loss and early functional recovery in primary total knee arthroplasty

“…What is more, the research by Hernandez et al proved that surgery time rather than tourniquet time was the main cause leading to DVT and that surgery lasting longer than 120 minutes increased the risk of DVT in TKA [34]. Anyhow, anticoagulant therapy and early ultrasound examination will make sense in prevention of post-operative DVT and pulmonary thromboembolism in TKA [35][36][37][38]. All patients received rivaroxaban administration after the TKA surgery, while no cases of symptomatic PE or DVT happened in our study.…”

The necessity of pharmacological prophylaxis against venous thromboembolism in major joint arthroplasty

“…However, the RR of clinically relevant bleeding was higher with rivaroxaban (RR 1.25; 95 % CI 1.05-1.49) and similar with dabigatran (RR 1.12; 95 % CI 0.94-1.35) [9]. These figures suggest that chemical agents with a greater efficacy in VTE prophylaxis come at the cost of a higher risk of bleeding [9][10][11]. Rivaroxaban may also be more cost-effective than enoxaparin, with a 30-day course of 10 mg rivaroxaban costing £63.00, compared with £121.20 for a 30-day course of 40 mg enoxaparin [12].…”

Edoxaban versus enoxaparin for the prevention of venous thromboembolism after total knee or hip arthroplasty: pooled analysis of coagulation biomarkers and primary efficacy and safety endpoints from two phase 3 trials

“…In a phase 2, dose-finding study in Japan, mean levels of D-dimer and F 1+2 increased after TKA and remained above baseline for 11 to 14 days in placebo-treated patients, whereas treatment with edoxaban after surgery significantly reduced levels of the coagulation biomarkers in a dose-dependent manner [20]. In a retrospective study of patients undergoing TKA in Japan, patients treated with edoxaban 15 mg once daily showed significant reductions in D-dimer relative to enoxaparin 20 mg twice daily or fondaparinux 1.5 mg once daily over a 2-week period following surgery [21]. …”