Safety and Efficacy of New Anticoagulants for the Prevention of Venous Thromboembolism After Hip and Knee Arthroplasty: A Meta-Analysis

详细信息    查看全文

• 作者：Brett T. Venker ; PharmD^a ; ^b ; Beejal R. Ganti ; PharmD^a ; ^c ; Hannah Lin ; BA^a ; ^d ; Elizabeth D. Lee ; MMS ; PA-C^a ; ^e ; Ryan M. Nunley ; MD^a ; ^f ; Brian F. Gage ; MD ; MSc^a ;
• 关键词：arthroplasty ; anticoagulant ; bleed ; deep vein thrombosis ; meta-analysis ; thromboembolism
• 刊名：The Journal of Arthroplasty
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：32
• 期：2
• 页码：645-652
• 全文大小：558 K
• 卷排序：32

文摘

Venous thromboembolism (VTE) is a common and potentially fatal complication of arthroplasty.MethodsWe reviewed randomized trials to determine which anticoagulant has the best safety and efficacy in hip and knee arthroplasty patients. We searched PubMed, MEDLINE, and EMBASE through January 2016.ResultsCompared to enoxaparin (most commonly dosed 40 mg once daily), the relative risk (RR) of VTE was lowest for edoxaban 30 mg once daily (0.49; 95% confidence interval [CI], 0.32-0.75), fondaparinux 2.5 mg once daily (0.53; 95% CI, 0.45-0.63), and rivaroxaban 10 mg once daily (0.55; 95% CI, 0.46-0.66), and highest for dabigatran 150 mg once daily (1.19; 95% CI; 0.98-1.44). The RR of major/clinically relevant bleeding was lowest for apixaban 2.5 mg twice daily (0.84; 95% CI; 0.70-0.99) and highest for rivaroxaban (1.27; 95% CI, 1.01-1.59) and fondaparinux (1.64; 95% CI, 0.24-11.35). Fondaparinux was the only agent that was more effective than enoxaparin 30 mg twice daily (VTE RR = 0.58; 95% CI, 0.43-0.76).ConclusionWith the possible exception of apixaban, newer anticoagulants that lower the risk of postoperative VTE increase bleeding.