Fondaparinux vs. enoxaparin for the prevention of venous thromboembolism after total hip replacement: A meta-analysis

Dong,Wen‑Jun; Qian,Hui‑Juan; Qian,Yan; Zhou,Ling; Hu,San‑Lian

doi:10.3892/etm.2016.3351

Fondaparinux vs. enoxaparin for the prevention of venous thromboembolism after total hip replacement: A meta-analysis

Authors:
- Wen‑Jun Dong
- Hui‑Juan Qian
- Yan Qian
- Ling Zhou
- San‑Lian Hu
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Affiliations: Department of Nursing, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
Published online on: May 18, 2016 https://doi.org/10.3892/etm.2016.3351
Pages: 969-974
Copyright: © Dong et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The aim of the study was to compare the efficacy and safety profiles of fondaparinux and enoxaparin in preventing the venous thromboembolism (VTE) after total hip replacement. A systematic literature search in the PubMed, EMBASE and Cochrane library databases was performed to identify relevant articles published in English since inception up to November 16, 2014. The efficacy outcomes were all VTE, total deep vein thrombosis (DVT) and symptomatic VTE, while the safety outcome was major bleeding. Four eligible studies were included in the meta‑analysis. The incidences of total VTEs and DVTs were significantly decreased with the use of fondaparinux when compared to enoxaparin [total VTE: risk ratio (RR)=0.59, 95% confidence interval (CI): 0.46‑0.74, P<0.01; total DVT: RR=0.58, 95% CI: 0.46‑0.74, P<0.01]. Significantly fewer symptomatic VTEs and major bleeding cases were observed for the enoxaparin group (symptomatic VTE: RR=2.62, 95% CI: 1.07‑6.45, P=0.04; major bleeding: RR=1.75, 95% CI: 1.20‑2.53, P<0.01). In conclusion, the pooled analysis revealed that, compared to enoxaparin, fondaparinux was significantly more effective in preventing VTE after total hip replacements in terms of total VTEs and DVTs, although this was accompanied with an increased risk of major bleeding. However, the pooled analysis of two small sample trials from Japan failed to demonstrate any significant advantage for fondaparinux compared to enoxaparin.

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1	Eikelboom JW, Karthikeyan G, Fagel N and Hirsh J: American Association of Orthopedic Surgeons and American College of Chest Physicians guidelines for venous thromboembolism prevention in hip and knee arthroplasty differ: what are the implications for clinicians and patients? Chest. 135:513–520. 2009. View Article : Google Scholar : PubMed/NCBI
2	Lee S, Hwang JI, Kim Y, Yoon PW, Ahn J and Yoo JJ: Venous thromboembolism following hip and knee replacement arthroplasty in Korea: a nationwide study based on claims registry. J Korean Med Sci. 31:80–88. 2016. View Article : Google Scholar : PubMed/NCBI
3	Kurtz S, Ong K, Lau E, Mowat F and Halpern M: Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 89:780–785. 2007. View Article : Google Scholar : PubMed/NCBI
4	Selby R and Geerts W: Prevention of venous thromboembolism: Consensus, controversies, and challenges. Hematology (Am Soc Hematol Educ Program). 2009:286–292. 2009.
5	Paolucci F, Clavies MC, Donat F and Necciari J: Fondaparinux sodium mechanism of action: Identification of specific binding to purified and human plasma-derived proteins. Clin Pharmacokinet. 41(Suppl 2): 11–18. 2002. View Article : Google Scholar : PubMed/NCBI
6	Keam SJ and Goa KL: Fondaparinux sodium. Drugs. 62:1673–1685, 1686–1687. 2002. View Article : Google Scholar : PubMed/NCBI
7	Geerts WH, Heit JA, Clagett GP, Pineo GF, Colwell CW, Anderson FA and Wheeler HB: Prevention of venous thromboembolism. Chest. 119(Suppl 1): 132S–175S. 2001. View Article : Google Scholar : PubMed/NCBI
8	Ibbotson T and Goa KL: Enoxaparin: An update of its clinical use in the management of acute coronary syndromes. Drugs. 62:1407–1430. 2002. View Article : Google Scholar : PubMed/NCBI
9	Turpie AG, Eriksson BI, Lassen MR and Bauer KA: Fondaparinux, the first selective factor Xa inhibitor. Curr Opin Hematol. 10:327–332. 2003. View Article : Google Scholar : PubMed/NCBI
10	Bergqvist D: Review of fondaparinux sodium injection for the prevention of venous thromboembolism in patients undergoing surgery. Vasc Health Risk Manag. 2:365–370. 2006. View Article : Google Scholar : PubMed/NCBI
11	Lassen MR, Bauer KA, Eriksson BI and Turpie AG: European Pentasaccharide Elective Surgery Study (EPHESUS) Steering Committee: Postoperative fondaparinux versus preoperative enoxaparin for prevention of venous thromboembolism in elective hip-replacement surgery: a randomised double-blind comparison. Lancet. 359:1715–1720. 2002. View Article : Google Scholar : PubMed/NCBI
12	Turpie AG, Bauer KA, Eriksson BI and Lassen MR: PENTATHALON 2000 Study Steering Committee: Postoperative fondaparinux versus postoperative enoxaparin for prevention of venous thromboembolism after elective hip-replacement surgery: a randomised double-blind trial. Lancet. 359:1721–1726. 2002. View Article : Google Scholar : PubMed/NCBI
13	Yokote R, Matsubara M, Hirasawa N, Hagio S, Ishii K and Takata C: Is routine chemical thromboprophylaxis after total hip replacement really necessary in a Japanese population? J Bone Joint Surg Br. 93:251–256. 2011. View Article : Google Scholar : PubMed/NCBI
14	Migita K, Bito S, Nakamura M, Miyata S, Saito M, Kakizaki H, Nakayama Y, Matsusita T, Furuichi I, Sasazaki Y, et al: Venous thromboembolism after total joint arthroplasty: results from a Japanese multicenter cohort study. Arthritis Res Ther. 16:R1542014. View Article : Google Scholar : PubMed/NCBI
15	Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J and Moher D: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 151:W65–94. 2009. View Article : Google Scholar : PubMed/NCBI
16	Higgins JPT and Green S: Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration. 2011.Available from. https://www.cochrane-handbook.org
17	Higgins JP, Thompson SG, Deeks JJ and Altman DG: Measuring inconsistency in meta-analyses. BMJ. 327:557–560. 2003. View Article : Google Scholar : PubMed/NCBI
18	Turpie AG, Bauer KA, Eriksson BI and Lassen MR: Fondaparinux vs enoxaparin for the prevention of venous thromboembolism in major orthopedic surgery: a meta-analysis of 4 randomized double-blind studies. Arch Intern Med. 162:1833–1840. 2002. View Article : Google Scholar : PubMed/NCBI
19	Angchaisuksiri P: Venous thromboembolism in Asia - an unrecognised and under-treated problem? Thromb Haemost. 106:585–590. 2011. View Article : Google Scholar : PubMed/NCBI