title: Use of oral direct factor Xa inhibiting anticoagulants in elective hip and knee arthroplasty: a meta-analysis of efficacy and safety profiles compared with those of low-molecular-weight heparins.
abstract: Assessing the efficacy and safety profiles of new oral direct Factor Xa (FXa) inhibiting anticoagulants compared with low-molecular-weight heparins (LMWHs) in elective total hip and knee arthroplasty (THA and TKA). The literature review only searched for randomised-controlled trials (RCTs) published before September 2011. Five eligible THA RCTs with a total of 12,184 patients and 5 eligible TKA RCTs with a total of 13,169 patients were identified. Mantel- Haenszel random-effects model was used to create meta-analyses of pooled data for each surgical group. The primary efficacy outcome was the risk of venous thromboembolism (VTE) and all-cause mortality, and the primary safety outcome was the risk of major bleeding. The THA and TKA primary efficacy outcome meta-analyses calculated relative risks (RR) of 0.55 (95% confidence interval 0.32 to 0.94) and 0.68 (95% confidence interval 0.53 to 0.87), respectively in favor of the oral direct FXa inhibitors. The primary safety outcome meta-analyses for the THA and TKA surgical groups revealed an RR of 1.27 (95% confidence interval 0.56 to 2.86) and 0.94 (95% confidence interval 0.44 to 1.98), which shows no significant difference between oral FXa inhibitors and LMWHs. This review demonstrated that oral direct FXa inhibitors have a superior efficacy to LMWHs when used as thromboprophylaxis in both THA and TKA. The safety profile of these new oral anticoagulants was not significantly different to that of LMWHs.
authors.affiliation: Trauma Unit, John Radcliffe Hospital, Oxford, UK.
authors.forename: Mohammed
authors.initials: M
authors.lastname: As-Sultany
authors.forename: Joseph
authors.initials: J
authors.lastname: Pagkalos
authors.forename: Sara
authors.initials: S
authors.lastname: Yeganeh
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Craigs
authors.forename: Nectarios
authors.initials: N
authors.lastname: Korres
authors.forename: Robert M
authors.initials: RM
authors.lastname: West
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Tsiridis
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D065427:Factor Xa Inhibitors; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D054556:Venous Thromboembolism / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D006495:Heparin, Low-Molecular-Weight