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| |  Apixaban Superior to Enoxaparin in Preventing Thromboembolism After Knee Surgery NEW YORK -- March 4, 2010 -- Apixaban is more convenient and effective an anticoagulant than enoxaparin in preventing venous thromboembolism after knee replacement surgery, according to a study published today in The Lancet. 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. Michael Rud Lassen, MD, Department of Orthopaedics, Horsholm Hospital, University of Copenhagen, 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 received either apixaban 2.5 mg twice daily (n = 976) or enoxaparin 40 mg once daily (n = 997). The primary outcome was a composite of deep vein thrombosis, non-fatal pulmonary embolism, and death from any cause. Of the patients in the apixaban group, 147 (15%) had a primary outcome event, compared with 243 patients (24%) in the enoxaparin group. There was no significant difference between the groups in the bleeding during treatment. “Apixaban 2.5 mg 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,” the authors wrote. “These favourable results might help surgeons to resolve their clinical dilemma when considering anticoagulant prophylaxis for total knee replacement,” they continued. “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.” In an accompanying commentary, Jawed Fareed, MD, Department of Pathology, Loyola University Medical Center, Maywood, Illinois, and Russell Hull, MD, University of Calgary, Calgary, Alberta, said: “We are potentially a step closer to the unmet need of oral antithrombotic therapy without need for monitoring. The ideal prophylactic drug would reduce the frequency of postoperative venous thromboembolism without causing bleeding and other complications in patients postoperatively. An ideal drug does not yet exist. The balance is fairly simple: a stronger anticoagulant effect is associated with fewer thrombotic events, but with a cost of increased occurrence of bleeding.”
SOURCE: The Lancet
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