Background Novel oral anticoagulants (NOACs) are now more often being prescribed following surgery to reduce the risk of thromboembolism. In this analysis we aimed to compare dabigatran with enoxaparin for thromboprophylaxis following total hip replacement (THR). Methods Online databases were searched for studies solely comparing dabigatran with enoxaparin for thromboprophylaxis following THR. Relevant studies were finalized after carefully assessing the titles and abstracts. The clinical outcomes including outcomes of efficacy and safety were considered as the endpoints. The updated version of RevMan software was used to carry out this statistical analysis. Risk ratios (RR) with 95% confidence intervals (CIs) were used to represent the results. Results A total number of 4 studies including 6168 participants were assigned to dabigatran following THR whereas 3370 participants were assigned to enoxaparin resulting in a total number of 9538 participants which were included in this analysis. The time frame for participants’ enrollment varied from year 2002 to year 2012. Results of this analysis showed that when dabigatran was compared with enoxaparin following THR, deep venous thrombosis (DVT) (RR: 0.97, 95% CI: 0.80 – 1.18; P = 0.77), venous thromboembolism (VTE) (RR: 0.92, 95% CI: 0.70 – 1.19; P = 0.51) and pulmonary embolism (RR: 0.83, 95% CI: 0.25 – 2.71; P = 0.76) were similarly manifested. In addition, major bleeding (RR: 1.25, 95% CI: 0.85 – 1.84; P = 0.26), fatal bleeding (RR: 2.50, 95% CI: 1.12 – 52.03; P = 0.55), minor bleeding (RR: 1.08, 95% CI: 0.89 – 1.32; P = 0.44), bleeding in a critical organ (RR: 2.98, 95% CI: 0.12 – 73.05; P = 0.50) and bleeding requiring blood transfusion (RR: 1.11, 95% CI: 0.77 – 1.59; P = 0.58) were still similarly manifested. However, when dabigatran 225 mg dosage was compared with enoxaparin, the risks for DVT (RR: 0.79, 95% CI: 0.63 – 1.00; P = 0.05) and VTE (RR: 0.65, 95% CI: 0.46 – 0.92; P = 0.02) were significantly lower with dabigatran without any increase in bleeding events. Conclusion It can be concluded that the NOAC dabigatran was equally effective compared to enoxaparin for thrombo-prophylaxis following THR. No significant thrombotic event was observed with dabigatran when compared to enoxaparin. However, a higher dosage of dabigatran was associated with significantly reduced DVT and VTE. Nevertheless, due to the several limitations of this analysis, the bleeding outcomes were inconclusive and therefore, the results should be confirmed in further newer studies.

The novel anticoagulant dabigatran versus enoxaparin for thromboprophylaxis following total hip replacement: a meta-analysis

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2026年3月9日

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Junwu Huang,
Juhua Ye

摘要

Background

Novel oral anticoagulants (NOACs) are now more often being prescribed following surgery to reduce the risk of thromboembolism. In this analysis we aimed to compare dabigatran with enoxaparin for thromboprophylaxis following total hip replacement (THR).

Methods

Online databases were searched for studies solely comparing dabigatran with enoxaparin for thromboprophylaxis following THR. Relevant studies were finalized after carefully assessing the titles and abstracts. The clinical outcomes including outcomes of efficacy and safety were considered as the endpoints. The updated version of RevMan software was used to carry out this statistical analysis. Risk ratios (RR) with 95% confidence intervals (CIs) were used to represent the results.

Results

A total number of 4 studies including 6168 participants were assigned to dabigatran following THR whereas 3370 participants were assigned to enoxaparin resulting in a total number of 9538 participants which were included in this analysis. The time frame for participants’ enrollment varied from year 2002 to year 2012. Results of this analysis showed that when dabigatran was compared with enoxaparin following THR, deep venous thrombosis (DVT) (RR: 0.97, 95% CI: 0.80 – 1.18; P = 0.77), venous thromboembolism (VTE) (RR: 0.92, 95% CI: 0.70 – 1.19; P = 0.51) and pulmonary embolism (RR: 0.83, 95% CI: 0.25 – 2.71; P = 0.76) were similarly manifested. In addition, major bleeding (RR: 1.25, 95% CI: 0.85 – 1.84; P = 0.26), fatal bleeding (RR: 2.50, 95% CI: 1.12 – 52.03; P = 0.55), minor bleeding (RR: 1.08, 95% CI: 0.89 – 1.32; P = 0.44), bleeding in a critical organ (RR: 2.98, 95% CI: 0.12 – 73.05; P = 0.50) and bleeding requiring blood transfusion (RR: 1.11, 95% CI: 0.77 – 1.59; P = 0.58) were still similarly manifested. However, when dabigatran 225 mg dosage was compared with enoxaparin, the risks for DVT (RR: 0.79, 95% CI: 0.63 – 1.00; P = 0.05) and VTE (RR: 0.65, 95% CI: 0.46 – 0.92; P = 0.02) were significantly lower with dabigatran without any increase in bleeding events.

Conclusion

It can be concluded that the NOAC dabigatran was equally effective compared to enoxaparin for thrombo-prophylaxis following THR. No significant thrombotic event was observed with dabigatran when compared to enoxaparin. However, a higher dosage of dabigatran was associated with significantly reduced DVT and VTE. Nevertheless, due to the several limitations of this analysis, the bleeding outcomes were inconclusive and therefore, the results should be confirmed in further newer studies.