A comparison of apixaban and dabigatran etexilate for thromboprophylaxis following hip and knee replacement surgery

TY - JOUR

T1 - A comparison of apixaban and dabigatran etexilate for thromboprophylaxis following hip and knee replacement surgery

AU - Mayer, Adriane

AU - Schuster, Philipp

AU - Fink, Bernd

PY - 2017/6

Y1 - 2017/6

N2 - INTRODUCTION: Patients who have undergone hip or knee replacement surgery are exposed to a high risk of developing a post-operative venous thromboembolus and so have a need for an effective, medication-based, thrombosis prophylaxis. New orally active anticoagulants have been available for a few years now. These specific substances directly block either thrombin (e.g., dabigatran etexilate) or Factor Xa (e.g., apixaban). It is not clear whether there are any efficacy differences between these two substances because there have never been any head-to-head studies carried out.MATERIALS AND METHODS: We have carried out a study comparing two new orally active anticoagulants dabigatran etexilate (Pradaxa®) and apixaban (Eliquis®) that were each given to two groups of 200 patients respectively, who had undergone elective hip or knee arthroplasty (100 each). Each patient was assessed for pre- and post-operative hemoglobin concentrations, post-operative blood loss, the number of transfused erythrocyte concentrates, the duration of wound secretion, clinical thromboembolic complications (deep vein thrombosis, pulmonary embolism, myocardial infarct), as well as gastrointestinal, intracranial or wound-related bleeding complications.RESULTS: Dabigatran etexilate treatment led to a significant increase in the duration of wound secretion in both arthroplasty groups when compared to apixaban: wound secretion lasted 1.2 days longer on average in the dabigatran etexilate group than in the apixaban group (4.1 ± 2.1 vs. 2.9 ± 1.8 days). There were no significant differences observed between the two anticoagulant groups when comparing pre- and post-operative Hb values, post-operative blood loss and the other clinical parameters.CONCLUSIONS: Thus, it appears that the direct thrombin inhibitor, dabigatran etexilate, is associated with a longer period of wound secretion following the implantation of hip and knee endoprostheses than that associated with the Factor Xa inhibitor, apixaban.

AB - INTRODUCTION: Patients who have undergone hip or knee replacement surgery are exposed to a high risk of developing a post-operative venous thromboembolus and so have a need for an effective, medication-based, thrombosis prophylaxis. New orally active anticoagulants have been available for a few years now. These specific substances directly block either thrombin (e.g., dabigatran etexilate) or Factor Xa (e.g., apixaban). It is not clear whether there are any efficacy differences between these two substances because there have never been any head-to-head studies carried out.MATERIALS AND METHODS: We have carried out a study comparing two new orally active anticoagulants dabigatran etexilate (Pradaxa®) and apixaban (Eliquis®) that were each given to two groups of 200 patients respectively, who had undergone elective hip or knee arthroplasty (100 each). Each patient was assessed for pre- and post-operative hemoglobin concentrations, post-operative blood loss, the number of transfused erythrocyte concentrates, the duration of wound secretion, clinical thromboembolic complications (deep vein thrombosis, pulmonary embolism, myocardial infarct), as well as gastrointestinal, intracranial or wound-related bleeding complications.RESULTS: Dabigatran etexilate treatment led to a significant increase in the duration of wound secretion in both arthroplasty groups when compared to apixaban: wound secretion lasted 1.2 days longer on average in the dabigatran etexilate group than in the apixaban group (4.1 ± 2.1 vs. 2.9 ± 1.8 days). There were no significant differences observed between the two anticoagulant groups when comparing pre- and post-operative Hb values, post-operative blood loss and the other clinical parameters.CONCLUSIONS: Thus, it appears that the direct thrombin inhibitor, dabigatran etexilate, is associated with a longer period of wound secretion following the implantation of hip and knee endoprostheses than that associated with the Factor Xa inhibitor, apixaban.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Antithrombins

KW - Arthroplasty, Replacement, Hip

KW - Arthroplasty, Replacement, Knee

KW - Dabigatran

KW - Dose-Response Relationship, Drug

KW - Factor Xa Inhibitors

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Osteoarthritis, Hip

KW - Osteoarthritis, Knee

KW - Postoperative Complications

KW - Pyrazoles

KW - Pyridones

KW - Thrombosis

KW - Treatment Outcome

KW - Comparative Study

KW - Journal Article

U2 - 10.1007/s00402-017-2697-8

DO - 10.1007/s00402-017-2697-8

M3 - SCORING: Journal article

C2 - 28439702

VL - 137

SP - 797

EP - 803

JO - ARCH ORTHOP TRAUM SU

JF - ARCH ORTHOP TRAUM SU

SN - 0936-8051

IS - 6

ER -