What is the role of direct oral anticoagulant (DOAC) agents in preventing venous thromboembolism (VTE) in patients who undergo hip or knee arthroplasties?

DOACs (eg, rivaroxaban, apixaban,and dabigatran) are increasingly considered for use after hip and knee arthroplasties due to their demonstrated efficacy against VTE prophylaxis and an acceptable safety profile. 

In a meta-analysis involving 16 trials in over 38,000 patients, when compared to enoxaparin, the risk of symptomatic VTE appeared to be significantly lower with rivaroxaban (relative risk 0.48, 95% C.I. 0.3-0.75), and similar with dabigatran and apixaban (1).

In the same study, compared to enoxaparin, the relative risk of clinically relevant bleeding was significantly higher with rivaroxaban (1.25, 95% C.I. 1.1-1.5), similar with dabigatran , but lower with apixaban (0.82, 95% C.I. 0.7-0.98) (1). The authors concluded that new anticoagulants did not differ significantly for efficacy and safety.

Of course, the decision to use a DOAC vs enoxaparin should be made on an individual basis taking into account a variety of factors,  such as patient preferences, cost, comorbidities, patient compliance with medications, etc…  

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 Reference

1.  Gomez-Outes, Suarez-Gea L, Vargas-Castrillon E.  Dabigatran, rivaroxaban, or apixaban versus enoxaparin for thromboprophylaxis after total hip or knee replacement: systematic review, meta-analysis, and indirect treatment. BMJ 2012;344:e3675. https://pubmed.ncbi.nlm.nih.gov/22700784/ 

 

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What is the role of direct oral anticoagulant (DOAC) agents in preventing venous thromboembolism (VTE) in patients who undergo hip or knee arthroplasties?