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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