Investigational once-daily oral, direct factor Xa inhibitor, Edoxaban ( Lixiana ), was shown to be superior to Enoxaparin ( Lovenox ) in preventing venous thromboembolic ( VTE ) events in patients following total knee replacement ( TKR ), a type of major orthopedic surgery.
STARS E-3 ( Studying Thrombosis After Replacement Surgery ) study evaluated the efficacy and safety of Edoxaban compared with Enoxaparin in patients undergoing TKR in Japan and Taiwan. A total of 716 patients received either 30 mg once-daily oral dose of Edoxaban or subcutaneous injection of Enoxaparin 2,000 international units ( equivalent to 20 mg ) twice-daily for 11 to 14 days.
The primary efficacy endpoint of the trial was the incidence of symptomatic pulmonary embolism and symptomatic and asymptomatic deep vein thrombosis. The primary safety endpoint was the incidence of major bleeding and clinically relevant non-major bleeding.
Deep vein thrombosis occurred in 7.4% of patients receiving Edoxaban once-daily compared with 13.9% of patients who received Enoxaparin ( relative risk reduction of 46.8%; p=0.01 ). There were no pulmonary embolism events observed in either treatment group. There was no statistically significant difference in major and clinically relevant non-major bleeding ( p=0.13 ). There were no cases of intracranial hemorrhage or death in either treatment group.
Indicators for potential liver damage in both treatment groups were carefully monitored during this trial by measuring bilirubin and serum aminotransferase levels. Elevations greater than three times the upper limit of the normal range of serum aminotransferase levels occurred in 1.4% of patients taking Edoxaban compared with 8% of those taking Enoxaparin.
Source: 21st International Congress on Thrombosis ( ICT ), 2010