Efficacy and safety of oral direct factor Xa inhibitor for thromboprophylaxis after total hip or knee replacement: a meta-analysis

Objective: The aim of this meta-analysis is to estimate efficacy and safety of different daily doses of oral direct factor Xa inhibitor for thromboprophylaxis after total hip or knee replacement. Methods: This paper searched the databases such as Pubmed, Medline, Web of Science and Embase databases. 15 RCT studies were included and dichotomousdata were presented as the risk ratio (RR) with a 95% confidence interval (CI). Results: 15 relevant studies with 28, 548 individuals and 3 different types of oral direct factor Xa inhibitor (apixaban, rivaroxaban and dabigatran) were employed for this meta-analysis. The efficacy of 5 mg, 10 mg and 20 mg daily doses of apixaban was superior to 40 mg daily of enoxaparin, but 10 mg and 20 mg daily doses of apixaban increased the risk of major bleeding and non-major but clinically relevant bleeding. Except the lowest daily dose of 5 mg, 10 mg, 20 mg, 30 mg, 40 mg and 60 mg daily doses of rivaroxaban had superior efficacy than 40 mg daily of enoxaparin, but higher doses of 30 mg, 40 mg and 60 mg showed lower safety than enoxaparin and 10 mg and 20 mg of rivaroxaban. 60 mg daily was better in efficacy than enoxaparin and other doses of darexaban. Meantime, the risk of bleeding was not significantly increasing. Conclusion: Consider the safety and efficacy, 5 mg daily of apixaban, 20 mg daily of rivaroxaban, 60 mg daily of darexaban were optimal potential oral direct factor Xa inhibitor for thromboprophylaxis after total hip or knee replacement.