Rivaroxaban Versus Low Molecular Weight Heparin For The Prevention Of Venous Thromboembolism After Orthopedic Surgery: A Population-Based Study
Notice bibliographique
Résumé
Abstract Introduction Venous thromboembolism (VTE) occurs in up to 25% of patients undergoing total hip (THA) or knee arthroplasty (TKA) without the use of prophylactic anticoagulation. Low molecular weight heparins (LMWH) are the standard agents for preventing VTE in this setting. In recent years, rivaroxaban, apixaban and dabigatran have been approved for this indication and, although results from randomized trials suggest that they are non-inferior and potentially superior to LMWH, information regarding outcomes in routine use is lacking. Objectives To evaluate the safety and efficacy of rivaroxaban for the prevention of VTE in patients undergoing THR or TKR in routine practice. Methods We conducted a population-based retrospective cohort study using linked healthcare databases in Ontario, Canada, including information on hospital discharge, emergency room visits, medication use, demographics and physician billing. In Ontario older patients have universal drug coverage and thus we included patients aged 66 years or older who received an outpatient prescription for a LMWH, (including dalteparin, tinzaparin and enoxaparin) or rivaroxaban after discharge from THR or TKR between 2002 and 2012 across 121 hospitals. Patients were excluded if they had other indications for anticoagulation. Primary efficacy and safety outcomes in the 30 days after surgery were the occurrence of an Emergency Room visit or hospitalization with a VTE (either deep vein thrombosis or pulmonary embolism) or a hospitalization with non traumatic major hemorrhage, respectively. Secondary outcomes included the previous 2 endpoints at 90 days as well as hospitalization for digestive system endoscopy (a proxy for gastrointestinal hemorrhage) and all cause mortality, both at 30 and 90 days after surgery. Unadjusted and adjusted odds ratios with 95% confidence intervals (CI) were obtained using logistic regression and reported as relative risks (RR) (appropriate given the incidence observed). Results The cohort included 24,321 patients and there was no significant difference on over 35 baseline characteristics between the LMWH (n=11,471) and rivaroxaban (n=12,850) groups. The median age for both groups was 73 years, 14,366 patients were women (59.1%) and 8,612 patients (35.4%) underwent THR. Anticoagulants were prescribed for a median of 14 days after discharge (interquartile range 10 to 21). The main results are shown in the table. Results were consistent in multiple additional analyses accounting for years rivaroxaban was approved in provincial formulary, adjusting for potential confounders, secular trends, individual LMWH, prescriber characteristics, and for subgroup analyses examining THR and TKR separately. Conclusions In this routine practice population-based study, the use of rivaroxaban compared to LMWH was associated with a lower risk of VTE without an increase in bleeding events. Financial Support Canadian Institutes of Health Research; ICES Western Scholars program. Disclosures: Lazo-Langner: Pfizer: Honoraria; Leo Pharma: Honoraria; Boehringer Ingelheim: Honoraria.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».