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Use of Oral Direct Factor Xa Inhibiting Anticoagulants in Elective Hip and Knee Arthroplasty: A Meta-analysis of Efficacy and Safety Profiles Compared with those of Low-Molecular-Weight Heparins

[ Vol. 11 , Issue. 3 ]


Mohammed As-Sultany, Joseph Pagkalos, Sara Yeganeh, Cheryl L. Craigs, Nectarios Korres, Robert M. West and Eleftherios Tsiridis   Pages 366 - 375 ( 10 )


Assessing the efficacy and safety profiles of new oral direct Factor Xa (FXa) inhibiting anticoagulants compared with low-molecular-weight heparins (LMWHs) in elective total hip and knee arthroplasty (THA and TKA). The literature review only searched for randomised-controlled trials (RCTs) published before September 2011. Five eligible THA RCTs with a total of 12,184 patients and 5 eligible TKA RCTs with a total of 13,169 patients were identified. Mantel- Haenszel random-effects model was used to create meta-analyses of pooled data for each surgical group. The primary efficacy outcome was the risk of venous thromboembolism (VTE) and all-cause mortality, and the primary safety outcome was the risk of major bleeding. The THA and TKA primary efficacy outcome meta-analyses calculated relative risks (RR) of 0.55 (95% confidence interval 0.32 to 0.94) and 0.68 (95% confidence interval 0.53 to 0.87), respectively in favor of the oral direct FXa inhibitors. The primary safety outcome meta-analyses for the THA and TKA surgical groups revealed an RR of 1.27 (95% confidence interval 0.56 to 2.86) and 0.94 (95% confidence interval 0.44 to 1.98), which shows no significant difference between oral FXa inhibitors and LMWHs. This review demonstrated that oral direct FXa inhibitors have a superior efficacy to LMWHs when used as thromboprophylaxis in both THA and TKA. The safety profile of these new oral anticoagulants was not significantly different to that of LMWHs.


Direct FXa inhibitors, low-molecular-weight heparin, meta-analysis, oral anticoagulants, total hip arthroplasty, total knee arthroplasty, venous thromboembolism.


Academic Department of Orthopaedics and Trauma, Aristotle University Medical School, University Campus GR 54124, Thessaloniki, Greece.

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