title: Safety and efficacy of edoxaban, an oral factor Xa inhibitor, versus enoxaparin for thromboprophylaxis after total knee arthroplasty: the STARS E-3 trial.
abstract: BACKGROUND
  This phase 3 trial compared the safety and efficacy of edoxaban, an oral direct factor Xa inhibitor, with enoxaparin sodium (enoxaparin) for thromboprophylaxis after total knee arthroplasty (TKA) in patients in Japan and Taiwan.
  
  
  METHODS
  In this randomized, double-blind, double-dummy study, patients received oral edoxaban 30 mg once daily beginning 6 to 24 hours postsurgery or enoxaparin 2000 IU (equivalent to 20 mg) subcutaneously twice daily beginning 24 to 36 hours postsurgery for 11 to 14 days. The primary efficacy endpoint was the composite of symptomatic pulmonary embolism and symptomatic and asymptomatic deep vein thrombosis. Safety endpoints included the incidence of major bleeding, clinically relevant non-major (CRNM) bleeding, major bleeding or CRNM bleeding, all bleeding events, adverse events, and adverse drug reactions.
  
  
  RESULTS
  Of 716 patients enrolled, 360 and 356 were randomized to receive edoxaban or enoxaparin, respectively. The primary efficacy outcome occurred in 22/299 (7.4%) and 41/295 (13.9%) patients in the edoxaban and enoxaparin groups, respectively (relative risk reduction=46.8%), indicating non-inferiority (P <0.001) and superiority (P=0.010) of edoxaban versus enoxaparin. In the edoxaban and enoxaparin groups, major bleeding occurred in 4/354 (1.1%) versus 1/349 (0.3%) patients (P=0.373); major or CRNM bleeding occurred in 22/354 (6.2%) versus 13/349 (3.7%) patients (P=0.129), respectively.
  
  
  CONCLUSIONS
  Edoxaban 30 mg once daily was more effective for thromboprophylaxis than subcutaneous enoxaparin 2000 IU twice daily following TKA and demonstrated a similar incidence of bleeding events.
authors.affiliation: The Department of Orthopedic Surgery, Japan Community Healthcare Organization, Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka 553-0003, Japan. Electronic address: fuji-th@umin.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Fuji
authors.affiliation: Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung, 833, Taiwan. Electronic address: w281211@adm.cgmh.org.tw.
authors.forename: Ching-Jen
authors.initials: CJ
authors.lastname: Wang
authors.affiliation: Department of Orthopedic Surgery, Takarazuka Daiichi Hospital, 19-5 Kogetsu-cho, Takarazuka, 665-0832, Japan. Electronic address: fujita@takarazuka-daiichi-hp.or.jp.
authors.forename: Satoru
authors.initials: S
authors.lastname: Fujita
authors.affiliation: International University of Health and Welfare, 8-10-16 Akasaka, Minato-ku, Tokyo 107-0002 Japan. Electronic address: yohko@iuhw.ac.jp.
authors.forename: Yohko
authors.initials: Y
authors.lastname: Kawai
authors.affiliation: Department of Clinical Cardiovascular Research, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan. Electronic address: mashio@clin.medic.mie-u.ac.jp.
authors.forename: Mashio
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Clinical Planning Department, Daiichi Sankyo Co., Ltd, 1-2-58, Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan. Electronic address: kimura.tetsuya.d2@daiichisankyo.co.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Clinical Planning Department, Daiichi Sankyo Co., Ltd, 1-2-58, Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan. Electronic address: ibusuki.kei.tx@daiichisankyo.co.jp.
authors.forename: Kei
authors.initials: K
authors.lastname: Ibusuki
authors.affiliation: Asia Development Department, Daiichi Sankyo Co., Ltd, 1-2-58, Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan. Electronic address: ushida.hitoshi.e8@rdn.daiichisankyo.co.jp.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ushida
authors.affiliation: Clinical Data & Biostatistics Department, Daiichi Sankyo Co., Ltd., 1-2-58, Hiromachi, Shinagawa-ku, Tokyo 140-8710, Japan. Electronic address: abe.kenji.v7@daiichisankyo.co.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Abe
authors.affiliation: Department of Orthopedic Surgery, Mishuku Hospital, 5-33-12 Shimomeguro, Meguro-ku, Tokyo, 153-0051, Japan. Electronic address: s-tachi@mishuku.gr.jp.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Tachibana
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D004311:Double-Blind Method; D017984:Enoxaparin / Q000008:administration & dosage* / Q000009:adverse effects*; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D011725:Pyridines / Q000008:administration & dosage* / Q000009:adverse effects*; D018570:Risk Assessment; D013844:Thiazoles / Q000008:administration & dosage* / Q000009:adverse effects*; D013923:Thromboembolism / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D065427:Factor Xa Inhibitors; D011725:Pyridines; D013844:Thiazoles; C552171:edoxaban
keywords: edoxaban; enoxaparin; factor Xa; knee replacement arthroplasty; venous thromboembolism