Vascular Medicine, Kings College Hospital, London, UK.
Clin Appl Thromb Hemost. 2012 Nov;18(6):611-27. doi: 10.1177/1076029612437579. Epub 2012 Mar 2.
The present systematic review was conducted to assess the efficacy and safety of apixaban versus other anticoagulants, for the prevention of venous thromboembolism (VTE) following total hip replacement (THR) and total knee replacement (TKR) surgery. Electronic databases were interrogated to identify relevant randomized controlled trials. A series of direct/indirect comparisons and a network meta-analysis were conducted. Indirect comparisons found that the odds ratio of "all VTE and all-cause death" were significantly higher for dabigatran than for apixaban in patients with THR (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.50-4.21) and TKR (OR, 1.72; 95% CI, 1.22-2.42). Rivaroxaban showed similar efficacy to apixaban in patients with THR and TKR (OR, 0.69; 95% CI, 0.38-1.25 and OR, 0.83; 95% CI, 0.57-1.19, respectively). No significant differences were observed in bleeding outcomes between treatments. The novel anticoagulants apixaban, rivaroxaban, and dabigatran demonstrated similar or improved efficacy and similar safety compared with current therapies in this indication.
本系统评价旨在评估阿哌沙班与其他抗凝剂在预防全髋关节置换术（THR）和全膝关节置换术（TKR）后静脉血栓栓塞（VTE）的疗效和安全性。通过电子数据库检索确定相关的随机对照试验。进行了一系列直接/间接比较和网络荟萃分析。间接比较发现，与阿哌沙班相比，达比加群在 THR（比值比 [OR]，2.51；95%置信区间 [CI]，1.50-4.21）和 TKR（OR，1.72；95% CI，1.22-2.42）患者中“所有 VTE 和全因死亡”的可能性更高。利伐沙班在 THR 和 TKR 患者中的疗效与阿哌沙班相似（OR，0.69；95%CI，0.38-1.25 和 OR，0.83；95%CI，0.57-1.19）。治疗之间在出血结局方面未观察到显著差异。在该适应证中，新型抗凝药阿哌沙班、利伐沙班和达比加群与现有治疗相比，显示出相似或改善的疗效和相似的安全性。
