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See also:
All DVT prophylaxis clinical trials
All clinical trials of new anticoagulants
All clinical trials of dabigatran 150mg
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Treatments
Studied treatment |
dabigatran etexilate 150 mg q.d. 28-35 days
|
Control treatment |
Enoxaparin 40 mg q.d. for 28-25 days
starting the evening before surgery
|
Concomittant treatment |
|
Remarks |
3 arms dabigatran 220mg, 150mg and placebo
|
Treatments description |
enoxaprin regimen |
started before surgery |
treatment duration |
28-35 days |
|
Patients
Patients |
Total hip replacement
|
Inclusion criteria |
aged 18 years or older; weight at least 40 kg; scheduled for primary elective unilateral total
hip replacement
|
Exclusion criteria |
any bleeding diathesis; history of
acute intracranial disease or haemorrhagic stroke;
major surgery, trauma, uncontrolled hypertension, or
myocardial infarction in the past 3 months;
gastrointestinal or urogenital bleeding, or ulcer disease
in the past 6 months; severe liver disease; alanine or
aspartate aminotransferase concentrations greater than
two times the upper limit of the normal range in the
past month; severe renal insuffi ciency (creatinine
clearance less than 30 mL/min); use of long-acting
non-steroidal anti-infl ammatory drugs
|
Remarks |
|
Baseline characteristics |
Age (mean), years |
64y |
Total hip replacement |
100% |
Total knee replacement |
0% |
Weight, kg, |
79 kg |
Female |
56% |
general anesthesia |
25% |
BMI (kg/m�) |
NA |
History of venous thromboembolism (%) |
2.5% |
Use of cement |
NA |
Estimated creatinine clearance >60 ml/min |
NA (mean 89 ml/min) |
Previous orthopedic surgery (%) |
NA |
Duration of surgery (min) |
86 min |
|
Method and design
Randomized effectives |
1174 / 1162 (studied vs. control) |
Blinding |
double blind |
Follow-up duration |
28-35 days, median 33d |
Number of centre |
115 |
Geographic area |
Europe, Australia, South Africa |
Hypothesis |
Non inferiority |
Primary endpoint |
total VTE and all-cause mortality |
Remarks |
|
Remarks / Comments
Results
Endpoint
Studied treat. n/N
Control treat. n/N
Graph
RR [95% CI]
All cause death
0 / 1167
0 / 1142
classic
0,98 [0,00;250,00]
asymptomatic DVT
63 / 871
56 / 894
1,15 [0,82;1,63]
non-fatal pulmonary embolism
1 / 1156
3 / 1142
classic
0,33 [0,03;3,16]
proximal DVT
28 / 885
32 / 914
0,90 [0,55;1,49]
Major bleeding
15 / 1163
18 / 1154
0,83 [0,42;1,63]
total VTE and all-cause mortality
75 / 874
60 / 897
1,28 [0,93;1,78]
Symptomatic deep-vein thrombosis
9 / 1156
1 / 1142
classic
8,89 [1,13;70,07]
distal DVT
35 / 871
24 / 894
classic
1,50 [0,90;2,50]
major VTE (fatal and non fatal DVT,PE)
38 / 888
36 / 917
1,09 [0,70;1,70]
0
2
1.0
Relative risks
|
Endpoint |
Events (%) |
Relative Risk |
95% CI |
Endpoint definition in the trial |
Ref |
Studied treat. |
Control treat. |
All cause death
|
0 / 1167 (0,0%) |
0 / 1142 (0,0%) |
0,98 |
[0,02;49,28] |
|
7600 |
asymptomatic DVT
|
63 / 871 (7,2%) |
56 / 894 (6,3%) |
1,15 |
[0,82;1,63] |
|
|
non-fatal pulmonary embolism
|
1 / 1156 (0,1%) |
3 / 1142 (0,3%) |
0,33 |
[0,03;3,16] |
|
|
proximal DVT
|
28 / 885 (3,2%) |
32 / 914 (3,5%) |
0,90 |
[0,55;1,49] |
asymptomatic |
|
Major bleeding
|
15 / 1163 (1,3%) |
18 / 1154 (1,6%) |
0,83 |
[0,42;1,63] |
|
7600 |
total VTE and all-cause mortality
|
75 / 874 (8,6%) |
60 / 897 (6,7%) |
1,28 |
[0,93;1,78] |
|
|
Symptomatic deep-vein thrombosis
|
9 / 1156 (0,8%) |
1 / 1142 (0,1%) |
8,89 |
[1,13;70,07] |
|
|
distal DVT
|
35 / 871 (4,0%) |
24 / 894 (2,7%) |
1,50 |
[0,90;2,50] |
asymptomatic |
|
major VTE (fatal and non fatal DVT,PE)
|
38 / 888 (4,3%) |
36 / 917 (3,9%) |
1,09 |
[0,70;1,70] |
|
|
The primary endpoint (if exists) appears in blod characters
|
Reference(s) used for data extraction:
7600: Eriksson BI, Dahl OE, Rosencher N, Kurth AA, van Dijk CN, Frostick SP, Prins MH, Hettiarachchi R, Hantel S, Schnee J, B�ller HRDabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, non-inferiority trial.Lancet 2007;370:949-56
|
Endpoint |
studied treat. |
control treat. |
mean diff |
Absolute risk reduction
|
Endpoint |
Events rate |
Absolute risk reduction (ARR) |
Studied treat. |
Control treat. |
asymptomatic DVT |
7,23% |
6,26% |
9,7‰
|
non-fatal pulmonary embolism |
0,87‰ |
2,63‰ |
-1,8‰
|
proximal DVT |
3,16% |
3,50% |
-3,4‰
|
Major bleeding |
1,29% |
1,56% |
-2,7‰
|
total VTE and all-cause mortality |
8,58% |
6,69% |
1,9%
|
Symptomatic deep-vein thrombosis |
7,79‰ |
0,88‰ |
6,9‰
|
distal DVT |
4,02% |
2,68% |
1,3%
|
major VTE (fatal and non fatal DVT,PE) |
4,28% |
3,93% |
3,5‰
|
Meta-analysis of all similar trials:
anticoagulant in DVT prophylaxis for orthopedic surgery
antithrombotics in DVT prophylaxis for elective hip replacement
antithrombotics in DVT prophylaxis for orthopedic surgery
direct antithrombins in DVT prophylaxis for all type of patients
new anticoagulants in DVT prophylaxis for elective hip replacement
new anticoagulants in DVT prophylaxis for orthopaedic surgery
new anticoagulants in DVT prophylaxis for all type of patients
Reference(s)
-
Eriksson BI, Dahl OE, Rosencher N, Kurth AA, van Dijk CN, Frostick SP, Prins MH, Hettiarachchi R, Hantel S, Schnee J, B�ller HR.
Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, non-inferiority trial..
Lancet 2007;370:949-56
Pubmed
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