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
| Autor: | Nigel J. Donnachie, Mohammed As-Sultany, Alan J. Highcock, Rosemary Finley |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class Pyridones medicine.medical_treatment Arthroplasty Replacement Hip Low molecular weight heparin Dabigatran Rivaroxaban Internal medicine medicine Humans Orthopedics and Sports Medicine Prospective Studies Prospective cohort study Arthroplasty Replacement Knee business.industry Anticoagulants Venous Thromboembolism Arthroplasty Exact test Relative risk Pyrazoles Apixaban business medicine.drug |
| Zdroj: | The Journal of arthroplasty. 35(11) |
| ISSN: | 1532-8406 |
| Popis: | Direct oral anticoagulants (DOACs) have promised superior efficacy to low molecular weight heparins in the prevention of venous thromboembolism (VTE) in total hip and knee arthroplasty. However, there are concerns about raised associated bleeding and wound problems with these agents. This study aims to evaluate and compare the efficacy and safety of the 3 DOAC drugs: rivaroxaban, dabigatran and apixaban.The primary outcome measures were rate of symptomatic VTE and major bleeding. Secondary outcome measures were wound healing problems and requirement for return to theater. A total of 2431 patients received one of the DOAC drugs as thromboprophylaxis following total hip arthroplasty (35 days) or total knee arthroplasty (14 days) between 2011 and 2015. Binary variables were compared between the 3 groups by using the chi-squared test or Fisher's exact test. Relative risks of selected primary and secondary end points were also calculated for the prespecified pairwise comparison.The overall symptomatic VTE rate was 2%. Rivaroxaban had a statistically significant superior efficacy for overall VTE prevention (0.8% vs 2.6%) compared with dabigatran (P.01) and apixaban (P.01), and deep vein thrombosis prevention (0.3% vs 2.2%) over dabigatran (P.01). The overall rate of major bleeding was 1.2% with no significant difference observed between the 3 studied drugs.All 3 drugs had symptomatic VTE rates comparable with low molecular weight heparin from the published literature. Rivaroxaban appears to have superior efficacy in VTE prevention over apixaban and dabigatran. No statistical difference was observed for major bleeding with any of the 3 agents. |
| Databáze: | OpenAIRE |
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