Darexaban (YM150) versus enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a randomised phase IIb dose confirmation study (ONYX-3)

Bengt I. Eriksson; Giancarlo Agnelli; Alexander S. Gallus; Michael R. Lassen; Martin H. Prins; Ronny W. Renfurm; Makoto Kashiwa; Alexander G. G. Turpie

doi:10.1160/TH13-04-0296

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2014; 111(02): 213-225
DOI: 10.1160/TH13-04-0296

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Darexaban (YM150) versus enoxaparin for the prevention of venous thromboembolism after total hip arthroplasty: a randomised phase IIb dose confirmation study (ONYX-3)

Authors

Bengt I. Eriksson

¹Sahlgrenska University Hospital, Gothenburg, Sweden
Giancarlo Agnelli

²University of Perugia, Perugia, Italy
Alexander S. Gallus

³Flinders Medical Centre, Adelaide, Australia
Michael R. Lassen

⁴Spine Center Copenhagen, Copenhagen University Hospital, Glostrup, Denmark
Martin H. Prins

⁵University of Maastricht, Maastricht, The Netherlands
Ronny W. Renfurm

⁶Astellas Pharma Global Development Europe, Leiden, The Netherlands

⁷Department of Cardiology C5-P, Leiden University Medical Center, Leiden, The Netherlands
Makoto Kashiwa

⁸Astellas Pharma Inc, Tokyo, Japan
Alexander G. G. Turpie

⁹Hamilton General Hospital, Hamilton, Canada

Abstract

Summary

This double-blind, double-dummy, randomised, phase IIb study (NCT00902928) evaluated different dosing regimens of darexaban compared with enoxaparin (randomised 1:1:1:1:1 to 15 mg twice daily [bid], 30 mg once daily [qd], 30 mg bid or 60 mg qd or enoxaparin 40 mg qd) in patients undergoing elective total hip arthroplasty. Patients, investigators, pharmacists and sponsor were all blinded to treatment allocation. Darexaban administration started 6-10 hours (h) post-surgery. Enoxaparin 40 mg qd administration started 12 ± 2 h before surgery. Treatment continued for 35 days. Bilateral venography was performed on Day 10 ± 2. The primary efficacy outcome was total VTEs (composite of proximal/distal deep-vein thrombosis, pulmonary embolism) or death, at Day 12. Total VTE rates were similar across all groups. There was no apparent difference in efficacy between onceand twice-daily darexaban (odds ratio [OR] 1.00; 95% confidence interval [CI] 0.71–1.42; p=0.988), or total daily dose (30 mg/day vs 60 mg/day; OR 0.81; 95% CI 0.57–1.15; p=0.244). There was no significant difference in major and/or clinically relevant non-major bleeding between darexaban qd or bid, or between total daily doses of 30 mg or 60 mg, and also for any dosing regimen of darexaban vs enoxaparin. Darexaban was well tolerated, without signs of liver toxicity. In conclusion, darexaban, administered qd or bid, and at total daily doses of 30 mg or 60 mg, appears to be effective for VTE prevention and was well tolerated. Data suggest no significant differences between a once- or twice-daily dosing regimen.

Keywords

Darexaban - enoxaparin - orthopaedic surgery - venous thromboembolism - bleeding

Full Text

References

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