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ORTHOFEED, Edition 4                                                                                 12


           Wound problem

           There  was  no  significant  difference  between
           the  three  DOACs  with  regards  to  wound

           problems  resulting  in  discontinuation  of  the
           study  drug  (0.4%,  0.7%,  and  0.1%  for

           rivaroxaban,    dabigatran,    and    apixaban,
           respectively). 2





                                        Table 1- Direct comparison of DOACs     2



                  Event               Rivaroxaban (n=800)       Dabigatran (n=911)        Apixaban (n=720)


                    VTE                      6 (0.8)                  27 (3.0)                  15 (2.1)


 Need for clinical assessment  Head to head comparison  DVT  2 (0.3)  20 (2.2)                  6 (0.8)

 Current  clinical  evidence  is  unclear  about   A  prospective  cohort  study  evaluated  the
                     PE                      4 (0.5)                  7 (0.8)                   9 (1.3)
 which  prophylactic  strategy  (or  strategies)   comparative  efficacy  and  safety  of  the  three

 is/are optimal or suboptimal for the prevention   DOACs: rivaroxaban, dabigatran, and apixaban,   Wound problem requiring   3(0.4)  6 (0.7)  1 (0.1)
                discontinuation
 of venous thromboembolic disease in patients   in a total of 2431 THA or TKA patients. 2

 undergoing elective hip and knee arthroplasty. 3
 Efficacy
                                                              2020;35(11):3093-3098.
 Prolonged  wound  drainage  after  lower-limb   Rivaroxaban  had  a  statistically  significant   Conclusion
 arthroplasty  is  associated  with  infection,   superior  efficacy  for  overall  VTE  (Venous   Rivaroxaban appears to have superior efficacy in   3) Jacobs JJ, Mont MA, Bozic KJ, et al. American
                                                              Academy of Orthopaedic Surgeons clinical practice
 longer  hospital  stay,  re-operation,  and   thromboembolism)  prevention  (0.8%  vs   VTE  prevention  over  apixaban  and  dabigatran,   guideline on: preventing venous thromboembolic disease
                                                              in patients undergoing elective hip and knee arthroplasty. J
 subsequent increase in the economic burden   2.6%) compared with dabigatran (P < 0.01)   whilst  no  significant  difference  is  observed  in   Bone Joint Surg Am. 2012;94(8):746-747.

 on national resources. 1  and apixaban (P < 0.01). 2  wound  problems  with  either  rivaroxaban,

        dabigatran or apixaban.  2
 Most  importantly,  there  is  a  dearth  of  direct   DVT (deep vein thrombosis) prevention was
 comparative study between the three DOACs   also superior with rivaroxaban compared to   References

 for antithrombotic efficacy and occurrence of   dabigatran  (0.3%  vs  2.2%)  and  apixaban
 wound problem. 2  (0.3% vs 0.8%) (Table 1). 2  1) Jensen CD, Steval A, Partington PF, Reed MR, Muller SD.
        Return to theatre following total hip and knee replacement,
        before and after the introduction of rivaroxaban: a
        retrospective cohort study. J Bone Joint Surg Br
 In this scenario, AAOS’ (American Academy of   Symptomatic  PE  (Pulmonary  embolism)   2011;93:91e5.
 Orthopaedic   Surgeons)   clinical   practice   was  low  across  all  study  groups,  with  an
        2) Highcock AJ, As-Sultany M, Finley R, Donnachie NJ. A
 guidelines are also unable to recommend for   overall rate of 0.8% (0.5%, 0.8%, and 1.3% in   Prospective Cohort Comparative Study of Rivaroxaban,
        Dabigatran, and Apixaban Oral Thromboprophylaxis in
 or  against  specific  prophylactics  in  these   the  rivaroxaban,  dabigatran,  and  apixaban   2431 Hip and Knee Arthroplasty Patients: Primary Efficacy
 patients. 3  groups, respectively). 2  Outcomes and Safety Profile. J Arthroplasty.
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