english.prescrire.org > Spotlight > Archives : 2012 > Apixaban. After hip or knee replacement: low-molecular-weight heparin remains the standard treatment

Spotlight: Archives

Every month, the subjects in Prescrire’s Spotlight.

2012 : 1 | 30 | 60 | 90

Apixaban. After hip or knee replacement: low-molecular-weight heparin remains the standard treatment

 FEATURED REVIEW  In 3 trials including a total of nearly 12 000 patients undergoing hip or knee replacement surgery, apixaban was not more effective than enoxaparin on relevant clinical endpoints. The bleeding risk was not lower with apixaban than with enoxaparin. It is better to continue to use a low-molecular-weight heparin such as enoxaparin.  
Full review (4 pages) available for download by subscribers.

Abstract

  • The standard anticoagulant for prevention of venous thromboembolism in patients undergoing hip or knee replacement surgery is a low-molecular-weight heparin (LMWH) such as subcutaneous enoxaparin.  
     
  • Apixaban is the second oral factor Xa inhibitor, after rivaroxaban, to be approved in the European Union for use in these two situations.  
     
  • Three double-blind randomised trials versus enoxaparin in a total of nearly 12 000 patients failed to show that apixaban was more effective in terms of relevant endpoints: mortality, and the incidence of pulmonary embolism and symptomatic deep vein thrombosis. 
     
  • The incidence of bleeding did not differ between the apixaban and enoxaparin groups under the conditions of these trials.
     
  • Apixaban is mainly metabolised by cytochrome P450 isoenzymes CYP 3A4 and 3A5 and also binds to P-glycoprotein, resulting in a high potential for pharmacokinetic interactions. Renal failure is a risk factor for overdose. Pharmacodynamic interactions are also likely.
     
  • There is no known antidote for apixaban.  
     
  • In practice, LMWH remains the standard treatment.
     

©Prescrire 1 September 2012

"Apixaban. After hip or knee replacement: LMWH remains the standard treatment" Prescrire Int 2012; 21 (130): 201-204. (Pdf, subscribers only)
Download the full review.
Pdf, subscribers only