Antithrombotic prophylaxis following total knee arthroplasty: a level I Bayesian network meta-analysis

source extracted confidence: high 2026-04-09
#humans #arthroplasty-replacement-knee #bayes-theorem #venous-thromboembolism #rivaroxaban

Antithrombotic prophylaxis following total knee arthroplasty: a level I Bayesian network meta-analysis

Migliorini et al., 2024 | Eur J Orthop Surg Traumatol | Systematic Review

Citation

Migliorini Filippo, Maffulli Nicola, ... Hofmann Ulf Krister. Antithrombotic prophylaxis following total knee arthroplasty: a level I Bayesian network meta-analysis. Eur J Orthop Surg Traumatol. 2024-Aug;34(6):2881-2890. doi:10.1007/s00590-024-04071-w

Abstract

INTRODUCTION: Venous thromboembolism (VTE) is a major concern following total knee arthroplasty (TKA). The optimal pharmacological prophylaxis remains, however, controversial. The present investigation compared several non-vitamin K antagonist oral anticoagulants commonly employed as VTE prophylaxis following TKA. A Bayesian network meta-analysis was conducted to compare apixaban, aspirin, dabigatran, edoxaban, enoxaparin, fondaparinux, and rivaroxaban. The outcomes of interest were to compare the rate of deep venous thrombosis (DVT), pulmonary embolism (PE), and major and minor haemorrhages. METHODS: This study was conducted according to the PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-Analyses of Health Care Interventions. In March 2024, PubMed, Web of Science, and Google Scholar were accessed with no time constraints. All randomised controlled trials (RCTs) comparing two or more drugs for the prevention of VTE following TKA were considered for inclusion. RESULTS: Data from 29,678 patients were collected. Of them, 67% (19,884 of 29,678 patients) were women. The mean age of the patients was 66.8 ± 2.8 years, and the mean BMI was 29.2 ± 1.5 kg/m2. There was comparability in age, sex, and BMI at baseline. Apixaban 5 mg, dabigatran 220 mg, and rivaroxaban 10 mg were the most effective in reducing the rate of DVT. Apixaban 5 mg, enoxaparin 60 mg, and rivaroxaban 40 mg were the most effective in reducing the rate of PE. Apixaban 5 mg, rivaroxaban 10 mg, and apixaban 10 mg were associated with the lowest rate of major haemorrhages. Apixaban 5 mg and 20 mg, and dabigatran 220 mg were associated with the lowest rate of minor haemorrhages. CONCLUSION: Administration of apixaban 5 mg demonstrated the best balance between VTE prevention and haemorrhage control following TKA. LEVEL OF EVIDENCE: Level I, network meta-analysis of RCTs.

Key Findings

Data from 29,678 patients were collected. Of them, 67% (19,884 of 29,678 patients) were women. The mean age of the patients was 66.8 ± 2.8 years, and the mean BMI was 29.2 ± 1.5 kg/m2. There was comparability in age, sex, and BMI at baseline. Apixaban 5 mg, dabigatran 220 mg, and rivaroxaban 10 mg were the most effective in reducing the rate of DVT. Apixaban 5 mg, enoxaparin 60 mg, and rivaroxaban 40 mg were the most effective in reducing the rate of PE. Apixaban 5 mg, rivaroxaban 10 mg, and api

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 29678
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Arthroplasty, Replacement, Knee
  • Bayes Theorem
  • Venous Thromboembolism
  • Rivaroxaban
  • Pyridones
  • Anticoagulants
  • Postoperative Complications
  • Dabigatran
  • Pyrazoles
  • Aspirin
  • Fibrinolytic Agents
  • Pulmonary Embolism
  • Enoxaparin
  • Hemorrhage
  • Female
  • Fondaparinux
  • Pyridines
  • Thiazoles

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Journal Article, Systematic Review, Network Meta-Analysis
  • Vertical: vitamin-k

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09