Alfarhan Mohammed Farhan A
Department of Surgery, Division of Orthopedics, College of Medicine, King Faisal University, Al-Ahsa 31982, Saudi Arabia.
J Pers Med. 2022 Jan 14;12(1):107. doi: 10.3390/jpm12010107.
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.
全髋关节置换术（THR）后，推荐预防性抗凝治疗以降低静脉血栓栓塞症（VTE）的风险。然而，尚不清楚哪种抗凝剂更优。因此，开展了一项随机双盲对照试验（RDBCTs）的系统评价和荟萃分析，以研究依诺肝素与新型口服抗凝剂相比，在预防THR后VTE方面的临床疗效和安全性。使用Cochrane图书馆、Scopus、科学网、Embase和PubMed/Medline数据库进行PICO检索策略。采用随机效应荟萃分析估计有症状VTE、临床相关出血、死亡率和净临床终点的相对风险（RR）。ITC和RevMan软件分别用于间接和直接比较。纳入了9项包含24584例患者的RDBCTs。与依诺肝素相比，利伐沙班有症状VTE风险降低（置信区间[CI]：0.32 - 0.77；RR：0.46%），与阿哌沙班（0.12 - 1.26；0.42%）和达比加群（0.22 - 2.20；0.70%）相当。与依诺肝素相反，利伐沙班临床相关出血风险更高（1.03 - 1.48；1.23%），与达比加群相当（0.96 - 1.33；1.10%），而阿哌沙班降低（0.19 - 5.66；0.96%）。在间接或直接比较中，干预措施在净临床终点上无差异。总之，这项荟萃分析的结果显示，在全髋关节置换术后预防VTE方面，新型口服抗凝剂与依诺肝素在疗效和安全性上无显著差异。
