Introduction:
Blood transfusions have been associated with poor outcomes in cardiac patients. The objective of our study was to systematically examine the overall risk of blood transfusion with new oral anticoagulants (NOACs) and individually in thromboprophylaxis for hip and knee surgery.
Hypothesis:
Treatment with NOACs is safe for short-term thromboprophylaxis in patients undergoing hip and knee surgery compared with conventional therapy.
Methods:
PubMed, Cochrane CENTRAL, EMBASE, EBSCO, Web of Science and CINAHL databases were searched from January 01, 2001 through September 30, 2013. Systemic review of randomized controlled trials (RCTs) comparing the use of NOACs (apixaban, dabigatran and rivaroxaban) with conventional therapy was performed. Clinical and outcome data were extracted from individual studies by 2 independent authors. Primary endpoint of interest was transfusion events in the NOAC and comparator arms. Random effects model was used to pool event rates and results were expressed as risk ratios (RR) with 95% confidence intervals (CIs).
Results:
Fifteen randomized controlled trials (RCTs) including a total of 36,176 patients were included for analysis. Transfusion events were not higher with use of NOACs in comparison to all comparators in patients undergoing hip and knee surgery- RR 1.02 (95% CI 0.98-1.06), p=0.40. Statistical heterogeneity was negligible (I2=22%).
Conclusions:
Blood transfusion events with NOAC use were not significantly higher than that with conventional drugs in thromboprophylaxis for hip and knee surgery patients, as noted in evidence from contemporary RCTs.
NOVEL ORAL ANTICOAGULANTS AND CONCOMITANT ANTIPLATELET THERAPY FOR STROKE PREVENTION IN PATIENTS WITH ATRIAL FIBRILLATION: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS