Preventive Effects of Different Drugs on Asymptomatic Lower Extremities Deep Venous Thrombosis After Artificial Joint Replacement: A Mixed Treatment Comparison

Abstract

This network meta-analysis aims to compare the preventive effects of 8 drugs (edoxaban, dabigatran, apixaban, rivaroxaban, warfarin, bemiparin, ximelagatran, and enoxaparin) on asymptomatic deep venous thrombosis (DVT) of lower extremities after artificial joint replacement. PubMed, Cochrane Library, and Embase were searched from their inception through October 2015 for randomized controlled trials comparing 8 drugs for the prevention of asymptomatic DVT of lower extremities after artificial joint replacement. Network meta-analysis combined the direct and indirect evidence to evaluate odd ratios (ORs) and surface under the cumulative ranking curves values. A total of 15 randomized controlled trials satisfying the inclusion criteria were enrolled. Edoxaban, apixaban, and rivaroxaban had poorer preventive effects on asymptomatic DVT of lower extremities after undergoing artificial joint replacement when compared with warfarin [OR = 0.16, 95% confidence interval (CI), 0.04–0.60; OR = 0.22, 95% CI, 0.07–0.64; OR = 0.16, 95% CI, 0.05–0.49, respectively]. When compared with enoxaparin, the preventive effects of edoxaban and rivaroxaban were poorer (OR = 0.37, 95% CI, 0.15–0.85; OR = 0.37, 95% CI, 0.21–0.59, respectively). The preventive effects of edoxaban and rivaroxaban were poorer than dabigatran (OR = 0.38, 95% CI, 0.14–0.99; OR = 0.38, 95% CI, 0.18–0.73, respectively). The surface under the cumulative ranking curves values showed that warfarin had better preventive effects on asymptomatic DVT of lower extremities after undergoing artificial joint replacement. Among the 8 drugs (edoxaban, dabigatran, apixaban, rivaroxaban, warfarin, bemiparin, ximelagatran, and enoxaparin), warfarin had better preventive effects on asymptomatic DVT of lower extremities after undergoing artificial joint replacement.