Abstract
Prophylactic anticoagulant therapy is recommended for reducing the risk of venous thromboembolism (VTE) after a total hip replacement (THR). However, it is not clear which anticoagulant is preferable. Hence, a systematic review and meta-analysis of randomized double-blind controlled trials (RDBCTs) were conducted to investigate the clinical efficacy and safety of enoxaparin in comparison with newer oral anticoagulants for the prevention of VTE after THR. The Cochrane Library, Scopus, Web of Science, Embase, and PubMed/Medline databases were used for PICO search strategy. Relative risks (RR) of symptomatic VTE, clinically relevant bleeding, mortality, and a net clinical endpoint were estimated employing a random effect meta-analysis. ITC and RevMan software were used for indirect and direct comparisons, respectively. Nine RDBCTs comprising 24,584 patients were included. As compared to enoxaparin, a reduced risk for symptomatic VTE was observed with rivaroxaban (confidence interval [CI]: 0.32–0.77; RR: 0.46%) and comparable with apixaban (0.12–1.26; 0.42%) and dabigatran (0.22–2.20; 0.70%). Contrarily to enoxaparin, a greater risk for clinically relevant bleeding was observed with rivaroxaban (1.03–1.48; 1.23%), comparable with dabigatran (0.96–1.33; 1.10%) and reduced with apixaban (0.19–5.66; 0.96%). In indirect or direct comparisons, the interventions did not differ on the net clinical endpoint. In conclusion, the findings of this meta-analysis revealed no significant difference in the efficacy and safety of new oral anticoagulants as compared to enoxaparin for the prevention of VTE after total hip replacement surgery.
Highlights
Total hip replacement (THR) is an effective and common treatment for degenerative joint diseases including osteoarthritis [1]
In indirect or direct comparisons, the interventions did not differ on the net clinical endpoint. The findings of this meta-analysis revealed no significant difference in the efficacy and safety of new oral anticoagulants as compared to enoxaparin for the prevention of venous thromboembolism (VTE) after total hip replacement surgery
The findings of the present review revealed that a greater efficacy of the newer oral anticoagulants is usually correlated with a greater tendency of bleeding in patients undergoing total hip replacement (THR)
Summary
Total hip replacement (THR) is an effective and common treatment for degenerative joint diseases including osteoarthritis [1]. Every patient undergoing joint replacement surgery is at risk of VTE due to decrease in perioperative mobility and duration of surgery. All such patients receive around 35 days of anticoagulation therapy after surgery for reducing the risk of VTE [3]. At 3 months, the rate of VTE after THR is variable (i.e., nearly 2% for PE and around 5% for DVT) among anticoagulated patients [4]. Anticoagulants to prevent VTE include newer oral agents
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
