title: Edoxaban versus enoxaparin for the prevention of venous thromboembolism after total knee or hip arthroplasty: pooled analysis of coagulation biomarkers and primary efficacy and safety endpoints from two phase 3 trials.
abstract: BACKGROUND
  The objective of this analysis was to assess the effects of edoxaban compared with enoxaparin on key coagulation biomarkers and present pooled primary efficacy and safety results from phase 3 STARS E-3 and STARS J-V trials for prevention of venous thromboembolism (VTE) after total knee arthroplasty (TKA) or total hip arthroplasty (THA).
  
  
  METHODS
  In the randomized, double-blind, double-dummy, multicenter, STARS E-3 and STARS J-V trials, patients received edoxaban 30 mg or enoxaparin 2000 IU (20 mg) twice daily for 11 to 14 days. The studies were conducted in Japan and Taiwan; enoxaparin dosing was based on Japanese label recommendations. The primary efficacy endpoint was incidence of VTE; the safety endpoint was major or clinically relevant nonmajor (CRNM) bleeding. Blood samples were taken at presurgical evaluation, pretreatment (postsurgery), predose on day 7, predose on completion of treatment, and at a follow-up examination 25 to 35 days after the last dose of study drug for D-dimer, prothrombin fragment 1 + 2 (F1+2), and soluble fibrin monomer complex (SFMC) measurement.
  
  
  RESULTS
  A total of 716 patients enrolled in STARS E-3 and 610 patients enrolled in STARS J-V; 1326 patients overall. This analysis included 657 patients who received edoxaban 30 mg QD and 650 patients who received enoxaparin 20 mg BID. Incidence of VTE was 5.1 and 10.7% for edoxaban and enoxaparin, respectively (P<0.001). Incidence of combined major and CRNM bleeding was 4.6 and 3.7% for edoxaban and enoxaparin, respectively (P= 0.427). On day 7, mean D-dimer (4.4 vs 5.5 μg/mL), F1+2(363 vs 463 pmol/L), and SFMC (5.7 vs 6.8 μg/mL) were lower in edoxaban-treated patients relative to enoxaparin-treated patients, respectively (P<0.0001 for all). At end of treatment, mean D-dimer (5.4 vs 6.2 μg/mL), F1+2(292 vs 380 pmol/L), and SFMC (6.2 vs 7.2 μg/mL) were lower in edoxaban-treated patients relative to enoxaparin-treated patients (P<0.0001 for all).
  
  
  CONCLUSIONS
  Edoxaban was superior to enoxaparin in prevention of VTE following TKA and THA, with comparable rates of bleeding events. Relative to enoxaparin, edoxaban significantly reduced D-dimer, F1+2, and SFMC.
  
  
  BACKGROUND
  Clintrials.gov NCT01181102 and NCT01181167. Both registered 8/12/2010.
authors.affiliation: International University of Health and Welfare, 8-10-16 Akasaka, Minato-ku, Tokyo 107-0052 Japan.
authors.forename: Yohko
authors.initials: Y
authors.lastname: Kawai
authors.affiliation: Department of Orthopaedic Surgery, Japan Community Healthcare Organization Osaka Hospital, 4-2-78, Fukushima, Fukushima-ku, Osaka 553-0003 Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Fuji
authors.affiliation: Department of Orthopaedic Surgery, Takarazuka Daiichi Hospital, 19-5 Kogetsu-cho, Takarazuka, 665-0832 Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Fujita
authors.affiliation: Daiichi Sankyo Co., Ltd, 3-5-1, Nihonbashi Honcho, Chuo-ku, Tokyo 103-8426 Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Daiichi Sankyo Co., Ltd, 3-5-1, Nihonbashi Honcho, Chuo-ku, Tokyo 103-8426 Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Ibusuki
authors.affiliation: Clinical Data & Biostatistics Department, Daiichi Sankyo Co. Ltd, 1-2-58, Hiromachi, Shinagawa-ku, Tokyo 140-8710 Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Abe
authors.affiliation: Department of Orthopaedic Surgery, Mishuku Hospital, 5-33-12 Shimomeguro, Meguro-ku, Tokyo 153-0051 Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Tachibana
keywords: Biomarker; DOAC; Total hip arthroplasty; Total knee arthroplasty; VTE prophylaxis