Apixaban versus enoxaparin for thromboprophylaxis after total hip or knee arthroplasty: a meta-analysis of randomized controlled trials / 中华医学杂志(英文版)
Chinese Medical Journal
;
(24): 2339-2345, 2012.
Article
Dans Anglais
| WPRIM
| ID: wpr-283762
ABSTRACT
<p><b>BACKGROUND</b>Enoxaparin is routinely used for prevention of venous thromboembolism (VTE) after total hip or knee arthroplasty. The purpose of this study was to compare the efficacy and safety of apixaban, a newly oral direct inhibitor of factor Xa versus enoxaparin.</p><p><b>METHODS</b>We performed a meta-analysis of relevant randomized-controlled trials (RCTs) identified in PubMed, Cochrane Library, Embase China Biological Medical Literature database, Countries Journal full-text database, VIP database, and WanFang database. The primary efficacy outcome for our meta-analysis was all VTE and all-cause mortality. The secondary efficacy outcomes included major VTE, non-fatal pulmonary embolism, and mortality. The primary safety outcome was bleeding events, categorized as major, clinically relevant non-major, or minor events.</p><p><b>RESULTS</b>Four RCTs, involving 14 065 patients, were included in our meta-analysis. Compared to enoxaparin, thromboprophylaxis with apixaban was associated with significantly fewer VTE and all-cause mortality (8346 patients, risk ratio (RR) 0.63, 95%CI 0.42 - 0.95) and similar incidence of bleeding events (major bleeding, 11 525 patients, RR 0.76, 95%CI 0.43 - 1.33; clinically relevant non-major bleeding, 11 525 patients, RR 0.83, 95%CI 0.69 - 1.01; and minor bleeding, 11 828 patients, RR 0.93, 95%CI 0.79 - 1.09). However, our meta-analysis revealed similar effects of apixaban with enoxaparin for thromboprophylaxis with regard to the secondary efficacy outcomes.</p><p><b>CONCLUSIONS</b>Apixaban was more effective than recommended dose of enoxaparin and had a similar safety profile for thromboprophylaxis after hip and knee arthroplasty. But more evidence, especially well designed head-to-head RCTs, is needed to confirm the superior efficacy of apixaban.</p>
Texte intégral:
Disponible
Indice:
WPRIM (Pacifique occidental)
Sujet Principal:
Pyrazoles
/
Pyridones
/
Essais contrôlés randomisés comme sujet
/
Énoxaparine
/
Arthroplastie prothétique de hanche
/
Arthroplastie prothétique de genou
/
Utilisations thérapeutiques
/
Thromboembolisme veineux
/
Méthodes
Type d'étude:
Essai clinique contrôlé
/
Étude pronostique
/
Revues systématiques évaluées
Limites du sujet:
Humains
langue:
Anglais
Texte intégral:
Chinese Medical Journal
Année:
2012
Type:
Article
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