Enoxaparin Versus Dabigatran or Rivaroxaban for Thromboprophylaxis After Hip or Knee Arthroplasty

Abstract

Background: Dabigatran etexilate and rivaroxaban have been approved in various countries for prevention of venous thromboembolism (VTE) after hip or knee arthroplasty but have not been directly compared with each other and their relative efficacy and safety is uncertain. Methods: We performed separate meta-analyses of pivotal randomized trials that compared equivalent durations of treatment with enoxaparin (40 mg once-daily [od] or 30 mg twice-daily) vs. dabigatran (220 mg od) or vs. rivaroxaban (10 mg od) to assess the clinically important efficacy (symptomatic VTE plus all-cause mortality) and bleeding (major plus clinically relevant non-major bleeding) outcomes. Results: Six trials with 18 405 patients were included (8185 comparing enoxaparin vs. dabigatran; and 10 220 comparing enoxaparin vs. rivaroxaban). Compared with dabigatran, enoxaparin had a similar risk of symptomatic VTE plus all-cause mortality and bleeding (Table). Compared with rivaroxaban, enoxaparin was associated with a 2-fold higher risk of symptomatic VTE plus all-cause mortality (P = 0.001, NNT = 167), but a significantly lower risk of bleeding (P = 0.049, NNH = 167). [Table represented.] Conclusion: In patients undergoing hip or knee arthroplasty, enoxaparin and dabigatran showed similar rates of efficacy and bleeding. Enoxaparin was less effective than rivaroxaban but had a lower risk of bleeding. These results may have important implications for the choice of prophylactic agent in major joint arthroplasty.