Antithrombotic prophylaxis following total knee arthroplasty: a level I Bayesian network meta-analysis.

Abstract

Venous thromboembolism (VTE) is a major concern following total knee arthroplasty (TKA). The optimal pharmacological prophylaxis remains, however, controversial. The present investigation compared several non-vitamin K antagonist oral anticoagulants commonly employed as VTE prophylaxis following TKA. A Bayesian network meta-analysis was conducted to compare apixaban, aspirin, dabigatran, edoxaban, enoxaparin, fondaparinux, and rivaroxaban. The outcomes of interest were to compare the rate of deep venous thrombosis (DVT), pulmonary embolism (PE), and major and minor haemorrhages. This study was conducted according to the PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-Analyses of Health Care Interventions. In March 2024, PubMed, Web of Science, and Google Scholar were accessed with no time constraints. All randomised controlled trials (RCTs) comparing two or more drugs for the prevention of VTE following TKA were considered for inclusion. Data from 29,678 patients were collected. Of them, 67% (19,884 of 29,678 patients) were women. The mean age of the patients was 66.8 ± 2.8years, and the mean BMI was 29.2 ± 1.5kg/m2. There was comparability in age, sex, and BMI at baseline. Apixaban 5mg, dabigatran 220mg, and rivaroxaban 10mg were the most effective in reducing the rate of DVT. Apixaban 5mg, enoxaparin 60mg, and rivaroxaban 40mg were the most effective in reducing the rate of PE. Apixaban 5mg, rivaroxaban 10mg, and apixaban 10mg were associated with the lowest rate of major haemorrhages. Apixaban 5mg and 20mg, and dabigatran 220mg were associated with the lowest rate of minor haemorrhages. Administration of apixaban 5mg demonstrated the best balance between VTE prevention and haemorrhage control following TKA. Level I, network meta-analysis of RCTs.