Safety and Efficacy of New Anticoagulants for the Prevention of Venous Thromboembolism After Hip and Knee Arthroplasty: A Meta-Analysis.
Venous thromboembolism (VTE) is a common and potentially fatal complication of arthroplasty.



We 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.



Compared 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).



With the possible exception of apixaban, newer anticoagulants that lower the risk of postoperative VTE increase bleeding.
Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri; Department of Pharmacy, Veterans Affairs San Diego Healthcare System, San Diego, California.
Brett T
BT
Venker
Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri; Department of Pharmacy Services, Henry Ford Hospital, Detroit, Michigan.
Beejal R
BR
Ganti
Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri; University of Massachusetts Medical School, Worcester, Massachusetts.
Hannah
H
Lin
Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri; Carolina Rehabilitation and Surgical Associates, Raleigh, North Carolina.
Elizabeth D
ED
Lee
Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri; Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri.
Ryan M
RM
Nunley
Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri.
Brian F
BF
Gage
D000925:Anticoagulants / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D000069604:Dabigatran; D017984:Enoxaparin; D000077425:Fondaparinux; D006470:Hemorrhage; D006801:Humans; D009025:Morpholines; D011134:Polysaccharides; D011720:Pyrazoles; D011728:Pyridones; D000069552:Rivaroxaban; D013876:Thiophenes; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D017984:Enoxaparin; D009025:Morpholines; D011134:Polysaccharides; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran; D000077425:Fondaparinux
anticoagulant; arthroplasty; bleed; deep vein thrombosis; meta-analysis; thromboembolism