Apixaban a better anticoagulant than Enoxaparin
Image credit: The Lancet
Today’s editorial is on an article published in today’s edition of The Lancet that found that Apixaban is better in preventing thromboembolism after knee replacement surgery compared to the current use of Enoxaparin.
“2·5 mg apixaban twice daily, starting on the morning after total knee replacement, offers a convenient and more effective orally administered alternative to 40 mg per day enoxaparin, without increased bleeding.”
Apixaban is more convenient and effective an anticoagulant than enoxaparin in preventing venous thromboembolism after knee replacement surgery. In addition, apixaban does not increase the risk of bleeding—a concern with anticoagulants, since this can delay recovery and predispose patients to infections that could damage the prosthesis.
Existing prophylactics such as heparins, like enoxaparin, or other drugs such as fondaparinux need regular injections, use of warfarin has various disadvantages in routine practice, and mechanical methods are cumbersome.
Michael Rud Lassen, Department of Orthopaedics, Horsholm Hospital, University of Copenhagen, Denmark, and colleagues undertook a randomised controlled phase 3 trial to see whether apixaban would be better than enoxaparin in both keeping thromboembolism and bleeding to a minimum. The patients either received 2.5 mg of apixaban twice daily or 40 mg enoxaparin once daily. The primary outcome was a composite of deep vein thrombosis, non-fatal pulmonary embolism, and death from any cause.
147 (15% of 976) patients on apixaban and 243 (24% of 997) on enoxaparin had a primary outcome event—a statistically significant difference. There was no significant difference between the groups in the bleeding during treatment.
The authors say: “2·5 mg apixaban twice daily, starting on the morning after total knee replacement, offers a convenient and more effective orally administered alternative to 40 mg per day enoxaparin, without increased bleeding.”
They conclude: “These favourable results might help surgeons to resolve their clinical dilemma when considering anticoagulant prophylaxis for total knee replacement. Bleeding can delay recovery and can predispose to infections that endanger the prosthesis. The small but occasionally important increase in surgical bleeding that is attributed to enoxaparin can contribute to underuse of effective prophylaxis.”