Use of Oral Direct Factor Xa Inhibiting Anticoagulants in Elective Hip and Knee Arthroplasty: A Meta-analysis of Efficacy and Safety Profiles Compared with those of Low-Molecular-Weight Heparins

Author(s): Mohammed As-Sultany, Joseph Pagkalos, Sara Yeganeh, Cheryl L. Craigs, Nectarios Korres, Robert M. West, Eleftherios Tsiridis.

Journal Name: Current Vascular Pharmacology

Volume 11 , Issue 3 , 2013

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Abstract:

Assessing the efficacy and safety profiles of new oral direct Factor Xa (FXa) inhibiting anticoagulants compared with low-molecular-weight heparins (LMWHs) in elective total hip and knee arthroplasty (THA and TKA). The literature review only searched for randomised-controlled trials (RCTs) published before September 2011. Five eligible THA RCTs with a total of 12,184 patients and 5 eligible TKA RCTs with a total of 13,169 patients were identified. Mantel- Haenszel random-effects model was used to create meta-analyses of pooled data for each surgical group. The primary efficacy outcome was the risk of venous thromboembolism (VTE) and all-cause mortality, and the primary safety outcome was the risk of major bleeding. The THA and TKA primary efficacy outcome meta-analyses calculated relative risks (RR) of 0.55 (95% confidence interval 0.32 to 0.94) and 0.68 (95% confidence interval 0.53 to 0.87), respectively in favor of the oral direct FXa inhibitors. The primary safety outcome meta-analyses for the THA and TKA surgical groups revealed an RR of 1.27 (95% confidence interval 0.56 to 2.86) and 0.94 (95% confidence interval 0.44 to 1.98), which shows no significant difference between oral FXa inhibitors and LMWHs. This review demonstrated that oral direct FXa inhibitors have a superior efficacy to LMWHs when used as thromboprophylaxis in both THA and TKA. The safety profile of these new oral anticoagulants was not significantly different to that of LMWHs.

Keywords: Direct FXa inhibitors, low-molecular-weight heparin, meta-analysis, oral anticoagulants, total hip arthroplasty, total knee arthroplasty, venous thromboembolism.

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Article Details

VOLUME: 11
ISSUE: 3
Year: 2013
Page: [366 - 375]
Pages: 10
DOI: 10.2174/1570161111311030011
Price: $58

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