Apixaban versus enoxaparin in patients with total knee arthroplasty

2011 ◽  
Vol 105 (02) ◽  
pp. 245-253 ◽  
Author(s):  
Jiahao Huang ◽  
Cun Liao ◽  
Liucheng Wu ◽  
Yunfei Cao ◽  
Feng Gao
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Major Bleeding ◽  
Safety Profile ◽  
Meta Analysis ◽  
Group Versus ◽  
Cochrane Central Register ◽  
Once Daily ◽  
Subcutaneous Enoxaparin ◽  
Total Knee

SummaryIt was the objective of this study to systematically compare the effects of apixaban versus enoxaparin in patients following total knee arthroplasty (TKA). A systematic search of Medline, EMBASE, Cochrane Central Register of Controlled Trials was conducted. Eligible studies were prospective, randomised control trials (RCT) of apixaban therapy, comparing with enoxaparin, in patients who have a high risk of venous thromboembolism (VTE) after TKA. Three RCTs involving 7,337 individuals were identified, of whom 4,057 were treated with apixaban 2.5 mg once daily, and 3280 were subcutaneous enoxaparin (40 mg once-daily or 30 mg twice-daily). Meta-analysis demonstrated the odds ratio (OR) for the composite of major VTE (proximal deep-vein thrombosis and pulmonary embolism) for apixaban versus enoxaparin was 0.47 (95% confidence interval [CI]: 0.27 to 0.82, 0.6% vs. 1.2%) and 2.09 (95%CI: 0.99 to 4.45, 0.6% vs. 0.3%), respectively. All-cause mortality occurred in 0.2% of the apixaban group versus 0.09% of the enoxaparin group (OR=1.74; 95%CI, 0.51 to 5.95). With respect to safety outcomes, apixaban was associated with a lower major bleeding rate than enoxaparin (OR=0.55, 95%CI: 0.32 to 0.96). No significant differences were detected between two strategies in other endpoints of safety profile analysed: clinically relevant non-major bleeding, raised hepatic transaminase enzyme or bilirubin concentrations and arterial thromboembolic events. In conclusion, apixaban is non-inferior to subcutaneous enoxaparin when used for the same duration, with considerable advantage regarding safety profile of major bleeding after TKA.

scholarly journals A comprehensive comparison between cementless and cemented fixation in the total knee arthroplasty: an updated systematic review and meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yuan Liu ◽  
Yi Zeng ◽  
Yuangang Wu ◽  
Mingyang Li ◽  
Huiqi Xie ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Functional Recovery ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Joint Infection ◽  
Standard Form ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Total Knee

Abstract Background Whether the cement should be used in the total knee arthroplasty (TKA) was still in controversy. This meta-analysis was performed to compare the efficacy of two kinds of fixation. Methods Randomized controlled trials (RCTs), prospective/retrospective observational studies from PubMed (on 2019 September), EMBASE (on 2019 September), and the Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science (on 2019 September) were searched. Only studies followed more than 2 years was included for the review. The PRISMA guidelines and Cochrane Handbook were adopted to assess the quality of the results reported in included studies to ensure that the results of our meta-analysis were reliable and veritable. The continuous and dichotomous outcomes were collected in a standard form, and the data were analyzed by Review Manager 5.3 software. Finally, the results were presented in the Forest plots. Results Twenty-six studies involving 2369 patients in cementless TKA and 2654 patients in cemented TKA were included. The rate of revision was not significantly different in two groups (p = 0.55). More than eight reasons caused revision were found in our study, the aseptic loosing was the most common, followed by the periprosthetic joint infection (PJI), neither was significantly different (p = 0.88 and 0.45, respectively). While significantly better long-term functional recovery was found in cementless TKA in terms of Knee Society Function Score (p = 0.004) and manipulation under anesthesia (p = 0.007). Conclusion Cementless fixation did not decrease the rate of revision after the total knee arthroplasty compared with the cemented fixation, while the long-term functional recovery was significantly better in the cementless group.

scholarly journals Persistent postoperative opioid use after total hip or knee arthroplasty: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Hui Ping Tay ◽  
Xinyi Wang ◽  
Sujita W Narayan ◽  
Jonathan Penm ◽  
Asad E Patanwala
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Total Hip Arthroplasty ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Opioid Use ◽  
Total Hip ◽  
Total Knee

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To identify the proportion of patients with continued opioid use after total hip or knee arthroplasty. Methods This systematic review and meta-analysis searched Embase, MEDLINE, the Cochrane Central Register of Controlled Trials, and International Pharmaceutical Abstracts for articles published from January 1, 2009, to May 26, 2021. The search terms (opioid, postoperative, hospital discharge, total hip or knee arthroplasty, and treatment duration) were based on 5 key concepts. We included studies of adults who underwent total hip or knee arthroplasty, with at least 3 months postoperative follow-up. Results There were 30 studies included. Of these, 17 reported on outcomes of total hip arthroplasty and 19 reported on outcomes of total knee arthroplasty, with some reporting on outcomes of both procedures. In patients having total hip arthroplasty, rates of postoperative opioid use at various time points were as follows: at 3 months, 20% (95% CI, 13%-26%); at 6 months, 17% (95% CI, 12%-21%); at 9 months, 19% (95% CI, 13%-24%); and at 12 months, 16% (95% CI, 15%-16%). In patients who underwent total knee arthroplasty, rates of postoperative opioid use were as follows: at 3 months, 26% (95% CI, 19%-33%); at 6 months, 20% (95% CI, 17%-24%); at 9 months, 23% (95% CI, 17%-28%); and at 12 months, 21% (95% CI, 12%-29%). Opioid naïve patients were less likely to have continued postoperative opioid use than those who were opioid tolerant preoperatively. Conclusion Over 1 in 5 patients continued opioid use for longer than 3 months after total hip or knee arthroplasty. Clinicians should be aware of this trajectory of opioid consumption after surgery.

scholarly journals Effectiveness and weakness of local infiltration analgesia in total knee arthroplasty: a systematic review

2018 ◽  
Vol 46 (12) ◽  
pp. 4874-4884 ◽  
Author(s):  
Zihao Zhang ◽  
Bin Shen
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Local Infiltration Analgesia ◽  
Local Infiltration ◽  
Central Register ◽  
Total Knee ◽  
Infiltration Analgesia

Local infiltration analgesia has been widely used for pain relief in patients undergoing total knee arthroplasty. However, the effectiveness and major weakness of this technique have not been clarified; therefore, improvements in the technique have been limited. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials and conducted a meta-analysis of randomized controlled trials comparing local infiltration analgesia with placebo infiltration in patients undergoing total knee arthroplasty. Fourteen trials involving 1305 knees were eligible. The results showed that local infiltration analgesia significantly reduced early perioperative pain and total narcotic consumption. However, postoperative functional outcomes were not significantly different between local infiltration analgesia and placebo. The pain-relieving effect of local infiltration analgesia was found to be strong but short in duration. In the future, modified delivery methods and formulas with longer durations of action and analgesia may provide a better environment for patients and therefore improve their function outcomes.

scholarly journals The role of perioperative intravenous low-dose dexamethasone in rapid recovery after total knee arthroplasty: a meta-analysis

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199822
Author(s):  
Youguang Zhuo ◽  
Rongguo Yu ◽  
Chunling Wu ◽  
Yuting Huang ◽  
Jie Ye ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Low Dose ◽  
Meta Analysis ◽  
Postoperative Nausea And Vomiting ◽  
Opioid Consumption ◽  
Cochrane Library ◽  
China National Knowledge Infrastructure ◽  
Postoperative Rehabilitation ◽  
Total Knee

Purpose The purpose of this meta-analysis was to evaluate the overall safety and effectiveness of perioperative intravenous dexamethasone to facilitate postoperative rehabilitation in patients after total knee arthroplasty (TKA). Methods A comprehensive literature search was performed using the Embase, PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases for relevant randomized controlled trials (RCTs) from inception to 2020. Methodological quality of the trials was assessed using the Cochrane Risk of Bias Tool, and the relevant data were extracted using a predefined data extraction form. Results Ten RCTs with 1100 knees were included. Our study showed a significant reduction in pain using a postoperative pain visual analog scale (VAS) at 24 hours and 48 hours, total opioid consumption at 24 hours and 48 hours, postoperative nausea and vomiting (PONV), active range of motion (ROM) limitation, and passive ROM limitation at 72 hours in dexamethasone-treated groups compared with controls. Conclusion Intravenous low-dose dexamethasone is potentially useful in the perioperative setting for reducing postsurgical immediate ROM limitations, pain, opioid consumption, and PONV. There are no data that directly attribute an increase in postoperative complications to intravenous dexamethasone. More high-quality studies are necessary to draw these conclusions.

scholarly journals Correction to: Better outcomes after mini‑subvastus approach for primary total knee arthroplasty: a Bayesian network meta‑analysis

2021 ◽  
Author(s):  
Filippo Migliorini ◽  
Paolo Aretini ◽  
Arne Driessen ◽  
Yasser El Mansy ◽  
Valentin Quack ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Bayesian Network ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Primary Total Knee Arthroplasty ◽  
Subvastus Approach ◽  
Total Knee ◽  
Primary Total Knee

A correction to this paper has been published: https://doi.org/10.1007/s00590-021-03026-9

Sign in / Sign up

Export Citation Format

Share Document