Outcome of Direct Oral Anticoagulant Treatment for Acute Lower Limb Deep Venous Thrombosis After Total Knee Arthroplasty Or Total Hip Arthroplasty

Abstract

Objective: The aim of this study was to examine the treatment outcomes of edoxaban and apixaban on deep venous thrombosis (DVT) in Japanese patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA).

Methods: We examined 100 patients receiving edoxaban or apixaban to treat lower limb DVT. The primary efficacy outcome was defined as the disappearance of DVT at three months post-treatment. The primary safety outcome was the change in hemoglobin (Hb) value after two and seven days of treatment compared with baseline, which was the start of treatment with edoxaban or apixaban.

Results: The primary efficacy outcome occurred in 61 of the 70 patients (87.1%) in the edoxaban group and in 28 of the 30 patients (93.3%) in the apixaban group. There was no significant difference between the edoxaban and apixaban groups in the disappearance of DVT at three months (p = .497). The change in Hb value from baseline to two days post-treatment was −0.53 ± 0.98 in the edoxaban group and −0.06 ± 0.75 in the apixaban group (p = .010). At seven days post-treatment, the changes in Hb were −0.03 ± 1.60 and 0.30 ± 0.68 (p = .007) in the edoxaban and apixaban groups, respectively.

Conclusion: Edoxaban and apixaban were equivalent in efficacy. However, apixaban was superior to edoxaban in terms of the change in Hb value. In cases of major bleeding, both edoxaban and apixaban need to be used carefully when treating DVT.

Keywords:

• Deep venous thrombosis
• total knee arthroplasty
• total hip arthroplasty
• edoxaban
• apixaban

Conflicts of interest

T. Mochizuki received honorariums for lectures from AbbVie, Inc., Bristol-Myers Squibb Co., Chugai Pharmaceutical Co., Daiichi Sankyo Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan Co., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., and Takeda Pharmaceutical Co., Ltd. K. Ikari received honorariums for lectures and/or unrestricted research grants from AbbVie, Inc., Asahi Kasei Pharma Corp., Astellas Pharma Inc., Bristol-Myers Squibb Co., Chugai Pharmaceutical Co., Eisai Co., Ltd. Hisamitsu Pharmaceutical Co. Inc., Janssen Pharmaceutical K.K., Kaken Pharmaceutical Co. Ltd., Mitsubishi Tanabe Pharma Co., Santen Pharmaceutical Co., Ltd., Taisho Toyama Pharmaceutical Co. Ltd., and Takeda Pharmaceutical Co., Ltd. K. Yano received honorariums for lectures from Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., Santen Pharmaceutical Co., Ltd. and Takeda Pharmaceutical Co., Ltd. K. Okazaki received honorariums for lectures and/or unrestricted research grants from Eli Lilly Japan Co., Smith & Nephew Co. Ltd., and Zimmer Biomet G. K. The other authors declare that they have no conflicts of interest. The sponsors were not involved in the study design; collection, analysis, and interpretation of data; writing of the paper; and/or decision to submit the results for publication.