doiSerbia

Prevention of venous thromboembolism with rivaroxaban and apixaban in orthopedic surgery

Antonijević Nebojša (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia), drantoni@gmail.com
Kanjuh Vladimir (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + Serbian Academy of Science and Arts, Committee on Cardiovascular pathology, Belgrade, Serbia)
Živković Ivana (Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia)
Jovanović Ljubica (Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia)
Vukčević Miodrag (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + Zemun Clinical Hospital Centre, Belgrade, Serbia)
Apostolović Milan (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + Banjica Institute for orthopedic surgery, Belgrade, Serbia)

Numerous limitations and side effects of standard anticoagulants require administering new anticoagulant drugs. New peroral anticoagulants of Factor Xa inhibitor group have more advantages, the key ones being: substantial reductions in specific nutrition limitations and drug interaction, no need for routine laboratory monitoring and greatly improved therapy predictability. Rivaroxaban, a selective peroral Factor Xa inhibitor is more effective compared with enoxaparin for venous thromboembolism (VTE) prophylaxis in major orthopedic interventions. Though several single trials demonstrated no difference in hemorrhagic complications, certain meta-analyses with rivaroxaban showed a higher incidence of hemorrhage. Apixaban, a peroral reversible inhibitor of factor Xa approved for the prevention of VTE, compared with European-approved doses of enoxaparin has the efficacy almost equal to the North-American-approved enoxaparin doses without a significant difference in bleeding rates, though АDVANCE I study points towards lower bleeding rates in patients treated with apixaban. To clarify the contradictory results of the recent meta-analysis related to the comparison between the stated factor X inhibitors and various comparator enoxaparin regimens as well as related to the risk for symptomatic PTE and total bleeding events following major orthopedic surgery, new research will be required. Specificities of rivaroxaban and apixaban, already constituting, according to modern recommendations, an integral part of the VTE prophylaxis protocols after major orthopedic interventions, will enable the establishment of personalized protocols aimed at developing an improved safety profile of each individual patient.

Keywords: prevention, venous thromboembolism, rivaroxaban, apixaban

Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 173008: Complex diseases as a model system for research the modulation phenotype-structural analysis of molecular biomarkers