Apixaban for prevention of venous thromboembolism after major orthopedic surgery: a Meta-analysis / 中华创伤杂志

ABSTRACT

Objective To systematically assess the clinical efficacy and safety of apixaban versus enoxaparin in the prevention of venous thromboembolism (VTE) after major orthopedic surgery.Methods Based on the principles and methods of Cochrane systematic review,the Cochrane Library,PubMed,EMBASE,Chinese Bio-medicine Database,China Journal Full-text Database,VIP Database were searched from their establishment to March 2012 in whatever languages.Related journals were handsearched as well.Randomized controlled trials (RCTs) of comparing apixaban and enoxaparin in the prevention of venous thromboembolism after major orthopedic operation were included.Cochrane Collaboration' s tool was used for assessing risk of bias in the included trials.Cochrane Collaboration' s software RevMan 5.1 was used for statistical analysis.Results Four RCTs totaling 12 897 patients were included.Apixaban treatment showed significant differences in aspects of total VTE and all-cause mortality [relative risk (RR) =0.63,95％ CI(0.41,0.96)],major VTE [RR =0.59,95％ CI(0.19,0.98)] and symptomatic deep vein thrombosis (DVT) [RR =0.50,95％ CI(0.26,0.97)] when compared with enoxaparin,but the difference in fatal pulmonary embolism was insignificant[RR =1.57,95％ CI(0.41,5.99)].For patients undergoing total knee arthroplasty,apixaban was associated with significantly fewer major bleeding events[RR =0.55,95％ CI(0.32,0.96)] and fewer total bleeding events[RR =0.79,95％ CI(0.66,0.95)] than enoxaparin.For patients undergoing total hip replacement,however,the two treatments revealed no statistically significant differences.With regard to the incidence of drug-related serious adverse events,the two treatments displayed no significant difference[RR =0.97,95％ CI(0.59,1.58)].Conclusion Apixaban is effective in the prevention of VTE after major orthopedic surgery and can significantly reduce the risk of postoperative VTE.