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VTE Prophylaxis Options Evaluated
J Thromb Haemost; ePub 2017 Jan 19; Kapoor, et al
Direct oral Xa inhibitors have a more favorable profile with regards to venous thromboembolism (VTE) and hemorrhage risk, compared with low-molecular-weight heparin (LMWH) Low, according to a recent meta-analysis. Meanwhile, vitamin K antagonists have a less favorable profile.
Investigators looked at VTE and hemorrhage information from randomized controlled trials published over a 26-year period ending in 2016, comparing 12 prophylaxis options in patients undergoing hip or knee replacement. They evaluated the relative risk of each option, compared to once-daily LMWH Low. Among the results:
- Direct oral Xa inhibitors had the lowest risk of total deep vein thrombosis (DVT).
- Vitamin K antagonists predicted 56% more DVT events.
- Though aspirin performed similarly, the numbers were too small to draw firm conclusions.
- Direct oral Xa inhibitors did not lead to significantly more bleeding.
- They prevented 4-fold more symptomatic DVTs.
The authors urged clinicians to consider these profiles when selecting prophylaxis options.
Kapoor A, Ellis A, Shaffer N, et al. Comparative effectiveness of venous thromboembolism prophylaxis options for the patient undergoing total hip and knee replacement: A network meta-analysis. [Published online ahead of print January 19. 2017]. J Thromb Haemost. doi:10.1111/jth.13566.