Synthesis Apixaban Vs Enoxaparin Research Proposal

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Hip replacement surgery puts its recipients at risk of deep venous thrombosis (DVT) or venous thromboembolism (VTE), whose complications include, but they are not limited to pulmonary embolism. With thousands of Americans opting for hip replacement every year, and statistics indicating that a significant percentage of patients develop thromboembolism after surgery, there is need to formulate and adopt an effective preventive plan to minimize the risk of DVT or VTE after hip replacement surgery. This assertion is supported by Pannucci, Dreszer, Wachtman, Bailey, Portschy, Hamill and Pusic (2011) who in their research point out that the relevance of studies on the prevention of Venous Thromboembolism cannot be overstated, especially given that VTE is today regarded an important post-operation patient safety concern. Two of the most commonly used options in venous thromboembolism prevention are apixaban and enoxaparin. In that regard, therefore, a review of how effective the two VTE and DVT mitigating mechanisms are and how each compares to the other is not only relevant, but also necessary. Apixaban works by inhibiting thrombi development (as a result of the formation of thrombin) via the inhibition of active factor Xa. In essence, therefore, it is an anticoagulant. Treatment duration using apixaban is often dependent on the kind orthopedic surgery – which determines a patient’s risk for venous thromboembolism. A kind of heparin, enoxaparin, is also an anticoagulant that helps in the activation of antithrombin III – thus effectively bringing about active factor Xa inhibition. Most studies cited herein made use of large samples. For generalization purposes, larger sample sizes in studies of this kind are largely representative, and hence aid validity

In a study seeking to compare enoxaparin to apixaban on the effectiveness front, Lessen, Gallus, Raskob, Pineo, Chen, and Ramirez (2010) found out that the later was more effective in VTE treatment than the former. Albeit for knee replacement surgery, Lassen, Raskob, Gallus, Pineo, Chen, and Hornick (2010) also point out that apixaban also has a wide efficacy rate in comparison to enoxaparin. In essence, knee replacement surgery has also been associated with the prevalence of deep vein thrombosis. This effectively means that some parallels can be drawn between knee replacement surgery and hip replacement surgery. Lassen et al. (2010) point out that in comparison to enoxaparin, apixaban has a high rate of safety and efficiency in the prevention of venous thromboembolism after a patient undergoes knee replacement surgery. This is further collaborated by the findings of a research undertaking by Nieto, Espada, Merino, and Gonzalez (2012) who set about to determine how effective oral anticoagulants were in the treatment of VTE after either hip or knee replacement. It is important to note that the findings of this study also link to findings from Lassen et al. (2010) due to the inclusion of knee replacement as a variable in the study, alongside hip replacement. The oral anticoagulants taken into consideration in this case were inclusive of apixaban. The authors found out that indeed, enoxaparin was less effective than apixaban in the treatment of VTE following either knee or hip surgery.

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However, unlike Lassen et al., (2010), Nieto, Espada, Merino, and Gonzalez (2012) gave the two interventions a similar safety score. In their study, Lassen et al. (2010) had found apixaban to be safer. On this basis it should be noted that no specific safety concern has been noted with regard to apixaban from previous clinical and nonclinical programs (Trkulja 2016). Findings by Nieto, Espada, Merino, and Gonzalez (2012) seem more applicable given the significant sample size used – in which case the authors recruited a total of 32,144 patients for the research undertaking. Further, unlike is the case in Lassen et al. (2010), the participants were in this case drawn from various countries from across the world. This is of great relevance when it comes to the generalizability of findings.

Like Lessen et al. (2010) Li, Sun, and Zhang (2012) rate apixaban as a more superior drug, in comparison to enoxaparin in the minimization of VTE occurrence post hip or knee surgery. However, unlike Lessen, most of the conclusions Li, Sun, and Zhang (2012) arrived at are on the basis of a review of available data on the issue. The mere assessment of previous studies could be viewed as a limitation of sorts as this does not in any way make meaningful additions to the existing body of research on this particular topic. Others who have found apixaban to be more effective in VTE prevention include Raskob, Gallus, Pineo, Chen, Ramirez, Wright, and Lessen. In their study, titled Apixaban versus enoxaparin for thromboprophylaxis after hip or knee replacement, Raskob et al. (2012) came to a similar conclusion to that of many others listed herein. They found that approximately 0.7 percent of apixaban patients suffered VTE, in comparison to approximately 1.5 of enoxaparin patients. Following similar conclusions from Yan, Gu, Zhou, Lin, and Wu (2016), these findings are not surprising. Yan et al. (2016) are of the opinion that enoxaparin does not compare to apixaban – with the latter being associated with better outcomes than the former. The only limitations to this study, unlike was the case with Raskob et al. (2012), is that the generalizability of its findings could be limited by its geographical limitation. However, unlike Yan et al. (2016), Raskob et al. (2012) left out an important variable, i.e. VTE-related mortality. This, in essence, limited the study’s applicability in a practice setting. The context of the study by Yen et al. (2016) was entirely China. Most studies cited in this text had a global context – with participants being of diverse racial, ethnic, and cultural extracts. However, unlike most authors, Yan et al. (2016) went further. They sought to determine how the two regimens compared on the cost effectiveness front. In a majority of cases, regimens with a higher efficacy rate tend to be also more costly than those reporting lower rates of efficacy. This assertion is upheld by Yen et al. (2016) who concluded that in comparison to apixaban, enoxaparin.....

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