Thromboprophylaxis with apixaban and the risk of pulmonary embolism in patients undergoing knee replacement surgery.
BACKGROUND
Apixaban, a novel oral anticoagulant, is also used for deep vein thrombosis (DVT) prophylaxis. In this study, we sought to critically evaluate the differences in the rates of symptomatic DVT and bleeding, and analyze the rates of pulmonary embolism (PE) in subgroups of patients from ADVANCE I and II trials given their similar indication and design.


METHODS
Studies were identified through electronic literature searches of MEDLINE, clinicaltrial.gov, SCOPUS, and EMBASE up to January 2014. Phase III RCTs involving use of apixaban and enoxaparin for thromboprophylaxis in patients undergoing total knee or hip replacement were included. Study-specific odds ratios were calculated and between-study heterogeneity was assessed using the I (2) statistics.


RESULTS
In three studies involving 11,659 patients, the risk of symptomatic DVT (pooled OR 0.38, 95% CI 0.16-0.90, I (2)=0%, p=0.03) and bleeding (pooled OR 0.87, 95% CI 0.77-0.99, I (2)=0%, p=0.03) was less in apixaban group compared to the enoxaparin group. However, it was interesting to note that on subgroup analysis, the risk of PE was higher with apixaban when used for thromboprophylaxis in knee replacement surgery (pooled OR 2.58, 95% CI 1.10-6.04, I (2)=0%, p=0.03).


CONCLUSIONS
Apixaban was found to be associated with lower risk of symptomatic DVT and bleeding compared to enoxaparin when used for thromboprophylaxis in patients undergoing knee and hip replacement surgeries. However, it was associated with higher risk of PE in patients undergoing knee replacement.
Department of Medicine, Reading Health System, Reading, PA, USA.
Madan Raj
MR
Aryal
Division of Cardiovascular Medicine, Mayo Clinic, AZ, USA; anil.pandit@hotmail.com.
Anil
A
Pandit
Department of Medicine, Reading Health System, Reading, PA, USA.
Sushil
S
Ghimire
Department of Medicine, Reading Health System, Reading, PA, USA.
Ranjan
R
Pathak
Department of Medicine, Reading Health System, Reading, PA, USA.
Paras
P
Karmacharya
Department of Medicine, Reading Health System, Reading, PA, USA.
Dilli Ram
DR
Poudel
Division of Cardiovascular Medicine, Mayo Clinic, AZ, USA.
Fadi E
FE
Shamoun
apixaban; arthroplasty; hip replacement; knee replacement; meta-analysis