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Dabigatran versus enoxaparin for prevention of venous thromboembolism after hip or knee arthroplasty: A pooled analysis of three trials |
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| Authors: | RJ Friedman OE Dahl JA Caprini CW Francis S Hantel BI Eriksson for the RE-MOBILIZE RE-MODEL RE-NOVATE Steering Committees |
| Institution: | a Medical University of South Carolina and Charleston Orthopedic Associates, Charleston, South Carolina, USA b Thrombosis Research Institute, London, United Kingdom and Elverum Central Hospital, Norway c Paris Descartes University and Cochin Hospital (AP HP), Paris, France d NorthShore University HealthSystem, Evanston IL and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA e University Medical Centre, Mainz, Germany f University of Rochester Medical Center, Rochester, New York, USA g Boehringer Ingelheim GmbH, Ingelheim, Germany h Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany i Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut, USA j University Hospital Sahlgrenska/Östra, Gothenburg, Sweden |
| Abstract: | BackgroundThree randomized, double-blind trials compared dabigatran, an oral direct thrombin inhibitor, with enoxaparin for the primary prevention of venous thromboembolism (VTE) in patients undergoing elective total hip and knee arthroplasty.Objectives and MethodsWe conducted a pre-specified pooled analysis of these trials. 8,210 patients were randomized, of whom 8,135 were treated (evaluable for safety) with dabigatran 220 mg or 150 mg once-daily, or subcutaneous enoxaparin (40 mg once-daily or 30 mg twice-daily). Efficacy analyses were based on the modified intention-to-treat population of 6,200 patients with an evaluable outcome. The common risk difference (RD) of treatment effect between each dabigatran dose and enoxaparin was estimated using fixed-effects models, and statistical heterogeneity was estimated using the I2 statistic.ResultsThe composite outcome of major VTE (proximal deep vein thrombosis and/or pulmonary embolism) and VTE-related mortality occurred in 3.3% of the enoxaparin group versus 3.0% of the dabigatran 220 mg group (RD vs. enoxaparin -0.2%, 95% CI -1.3% to 0.9%, I2 = 37%) and 3.8% of the 150 mg group (RD vs. enoxaparin 0.5%, -0.6% to 1.6%, I2 = 0%). Major bleeding occurred in 1.4% of the enoxaparin group versus 1.4% of the dabigatran 220 mg group (RD vs. enoxaparin -0.2%, -0.8% to 0.5%, I2 = 40%) and 1.1% of the 150 mg group (RD vs. enoxaparin -0.4%, -1.0% to 0.2%, I2 = 0%).ConclusionsOral dabigatran was as effective as subcutaneous enoxaparin in reducing the risk of major VTE and VTE-related mortality after hip or knee arthroplasty and has a similar bleeding profile. |
| Keywords: | Dabigatran Total knee arthroplasty Total hip arthroplasty Prophylaxis Venous thromboembolism |
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