阿哌沙班片(Eliquis)和利伐沙班片在膝关节置换术中抗凝效果的对比？

An experiment studied the anticoagulant effect of apixaban tablets (Eliquis) and rivaroxaban tablets after total knee surface replacement. The results showed that the anticoagulant effect of apixaban tablets (Eliquis) was better than that of rivaroxaban tablets. However, patients can choose which drug to use based on their own circumstances under the guidance of a doctor, and cannot choose blindly.

Apixaban Tablets (Eliquis)

Developed by Bristol-Myers Squibb, it is an oral direct inhibitor of factor Xa. It was launched after dabigatran etexilate and rivaroxaban. It is an oral anticoagulant. Apixaban tablets (Eliquis) were approved by the US FDA on December 28, 2012, for use in adult patients undergoing elective hip or knee replacement surgery to prevent venous thrombosis.

Rivaroxaban Tablets

Rivaroxaban Tablets are direct inhibitors of activated coagulation factor X and competitively target factor Xa through reversible binding. In November 2012, the US FDA approved rivaroxaban tablets to treat the formation of pulmonary embolism (PE) or deep vein thrombosis (DVT) and reduce the risk of recurrence after initial treatment of DVT and PE.

Rivaroxaban tablets have previously been approved by the FDA to reduce the risk of stroke in patients with non-valvular atrial fibrillation and to reduce the risk of DVT and PE after knee or hip replacement surgery.

Comparison of the anticoagulant effects of Apixaban Tablets (Eliquis) and Rivaroxaban Tablets in knee replacement surgery

Objective: To observe and compare the anticoagulant effects of the new oral anticoagulant drug Apixaban Tablets (Eliquis) and Rivaroxaban Tablets in total knee joint surface replacement surgery.

Methods: This study took 60 patients who received apixaban tablets (Eliquis) from October 2013 to September 2014 at the Orthopedic Joint Center of the First Affiliated Hospital of Chongqing Medical University as the research subjects, and randomly divided them into 30 patients.

Apixaban tablets (Eliquis) 2.5 mg were taken orally 24 hours after surgery, twice a day for 14 consecutive days. Thirty patients were treated with rivaroxaban, 10 mg of rivaroxaban was taken orally once a day starting from 24 hours for 14 days.

Observe and compare the changes in D-dimer, the occurrence of subcutaneous ecchymoses, postoperative blood loss, the formation of venous thrombosis and pulmonary embolism, the range of motion of artificial joints, and the changes in postoperative limb circumference between the two groups of patients.

Results: During the postoperative medication treatment, no deep vein thrombosis and pulmonary embolism occurred in the two groups during the treatment, and there was no significant bleeding compared with the control group. The invisible blood loss of patients in the apixaban tablets (Eliquis) group on days 3, 7, and 14 after treatment was significantly less than the hidden blood loss on days 3, 7, and 14 of the rivaroxaban tablets group.

After treatment with apixaban tablets (Eliquis), the incidence rate of subcutaneous ecchymosis was 26.67% (30/30), while the incidence rate of subcutaneous ecchymosis in the rivaroxaban tablets group was 63.33% (19/30).

There were no significant differences in the operation time, the change in the circumference of the operative limb, the change in D-dimer after surgery, and the range of motion of the knee joint between the two groups of patients.

Conclusion: During artificial knee replacement, taking rivaroxaban tablets and apixaban tablets (Eliquis) can effectively prevent the occurrence of venous thrombosis in the lower limbs. However, during the entire medication period, Apixaban Tablets (Eliquis) had less impact on patients' hidden postoperative blood loss, lower incidence of subcutaneous ecchymosis, and better clinical effect.

In addition, some studies have shown that compared with rivaroxaban tablets, the subcutaneous ecchymosis area of ​​apixaban tablets (Eliquis) for total knee replacement is smaller and disappears faster. Therefore, apixaban tablets (Eliquis) have a better anticoagulant effect after total knee surface replacement and are worthy of clinical promotion.

Safety comparison of apixaban tablets (Eliquis) and rivaroxaban tablets

Background: Apixaban tablets (Eliquis) and rivaroxaban tablets are replacing vitamin K antagonists in the treatment of venous thromboembolism (VTE) in adults, however, head-to-head comparisons are still limited.

Objective: To evaluate the safety of apixaban tablets (Eliquis) and rivaroxaban tablets in the treatment of patients with VTE.

Results: Among 49,900 eligible VTE patients, 18,618 were new users of apixaban tablets (Eliquis) and 18,618 were new users of rivaroxaban tablets. The median follow-up time for apixaban (Eliquis) users was 102 days, and the median follow-up time for rivaroxaban users was 105 days. After propensity score matching, apixaban tablets (Eliquis) were associated with lower VTE recurrence and bleeding rates.

Compared with rivaroxaban tablets, the absolute reduction in the probability of VTE recurrence within 2 months after treatment with apixaban tablets (Eliquis) was 0.006 and within 6 months after treatment was 0.011. Compared with rivaroxaban tablets, apixaban tablets (Eliquis) reduced the absolute probability of gastrointestinal tract and intracranial disease by 0.011 within 2 months after taking the drug, and by 0.015 within 6 months after taking the drug.

Summary

Apixaban tablets (Eliquis) and rivaroxaban tablets are both effective in preventing the formation of venous thrombosis in the lower limbs during knee replacement surgery, and have minimal adverse reactions. It is recommended that patients use the medication correctly under the guidance of a doctor.

References

[1] Ma Tao. Comparison of the anticoagulant effects of apixaban and rivaroxaban after total knee replacement [D]. Chongqing Medical University, 2016.

[2] Cai Pengde, Gu Enyi, Chen Kangyao, et al. Clinical analysis of subcutaneous ecchymosis after total knee replacement using apixaban and rivaroxaban anticoagulation Clinical Observation[J]. Journal of Clinical Rational Drug Use, 2019, 12(07):90-91.DOI:10.15887/j.cnki.13-1389/r.2019.07.050.

[3]Dawwas GK, Leonard CE, Lewis JD, Cuker A.

Risk for Recurrent Venous Thromboembolism and Bleeding With Apixaban

Compared With Rivaroxaban: An Analysis of Real-World Data. Ann Intern

Med. 2022 Jan;175(1):20-28. doi: 10.7326/M21-0717. Epub 2021 Dec 7.

Erratum in: Ann Intern Med. 2022 Nov;175(11):1627-1628. PMID: 34871048.

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