Apixaban or Enoxaparin for Thromboprophylaxis after Knee Replacement

• Published in: The New England journal of medicine Vol. 361; no. 6; pp. 594 - 604
• Main Authors: Lassen, Michael Rud, Raskob, Gary E, Gallus, Alexander, Pineo, Graham, Chen, Dalei, Portman, Ronald J
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 06.08.2009
• Subjects: Adult; Aged; Aged, 80 and over; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Arthroplasty, Replacement, Knee; Biological and medical sciences; Blood clots; Clinical outcomes; Clinical trials; Double-Blind Method; Drug therapy; Enoxaparin - adverse effects; Enoxaparin - therapeutic use; Factor Xa Inhibitors; Female; General aspects; Hemorrhage - chemically induced; Humans; Joint replacement surgery; Knee; Male; Medical sciences; Middle Aged; Postoperative Care; Postoperative Complications - prevention & control; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Pyrazoles - adverse effects; Pyrazoles - therapeutic use; Pyridones - adverse effects; Pyridones - therapeutic use; Venous Thromboembolism - prevention & control; Vascular disease; Knee; Medicine; Prevention; Prosthesis; Apixaban; Antithrombotic agent; Cardiovascular disease; Low molecular weight heparin; Anticoagulant; Thrombosis; Enoxaparin sodium
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa0810773

This noninferiority trial compared enoxaparin, a subcutaneously administered, low-molecular-weight heparin, with apixaban, an orally active inhibitor of factor Xa, for thromboprophylaxis after major knee surgery. Statistically, the noninferiority of apixaban was not demonstrated, but its use was associated with lower rates of clinically relevant bleeding. Statistically, the noninferiority of apixaban was not demonstrated, but its use was associated with lower rates of clinically relevant bleeding. The use of heparins, vitamin K antagonists, and mechanical methods to prevent venous thromboembolism after major joint surgery is now standard practice. 1 Despite effective prophylaxis, subclinical venous thrombosis develops soon after surgery in 15 to 20% of patients who undergo hip replacement and in 30 to 40% of those who undergo knee replacement 2 ; symptomatic venous thromboembolism develops within 3 months after surgery in 2 to 4% of patients undergoing hip or knee replacement. 3 , 4 Currently available prophylactic methods have practical limitations, since they require subcutaneous injection (the heparins) or careful dose adjustment (vitamin K antagonists) or tend to be . . .