In the ADVANCE-3 trial 5,407 hip replacement patients were randomized to receive thromboprophylaxis with either the new oral factor Xa inhibitor apixaban or enoxaparin. The rate of DVT, nonfatal PE, or death from any cause was 1.4% in the apixaban group compared to 3.9% in the enoxaparin group (RR 0.36, CI 0.22-0.54, P<0.001), thereby demonstrating both noninferiority and superiority of apixaban. The rate of major and clinically relevant nonmajor bleeding was 4.8% with apixaban and 5.0% with enoxaparin.
In an editorial accompanying the article (and also accompanying the appearance in print of the EINSTEIN-DVT trial), Elaine Hylek writes that “the oral factor Xa inhibitors represent a major advance in the prevention and treatment of thromboembolic disease.” But Hylek cautions that results with these agents in the real world may not be quite as rosy as in the clinical trials: “Because both the risk of thrombosis and the risk of hemorrhage increase substantially with age and with burden of chronic disease, the effectiveness of the novel agents in real-world practice will need to be closely monitored, particularly among older adults with renal impairment.”
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can you please say the clinical efficacy of apixaban in patients of age 7o years undergoing hip replacement surgery