OBJECTIVES: The objective of this meta-analysis was to systematically review the randomized clinical trials (RCTs) of Apixaban 2.5 mg twice daily versus low molecular weight heparins (LMWH) at the titrated dose for the prophylaxis of venous thromboembolism (VTE) among the patients who are at risk as per Virchow’s triad.

METHODS: Systematic search in the database e.g. EMBASE, MEDLINE, Cochrane Library, ProQuest, Science Direct, Google Scholar and clinicaltrials.gov was done to identify RCTs evaluating both interventions for the prophylaxis of VTE among patients at risk published in English language from year 2006 to 2017. A web-based systematic review tool “Covidence” was used to systematically screen the studies of interest. Analysis in “RevMan” was performed with the relative odds based on the random effect model. Results were presented as odds ratios (OR) with their 95% confidence intervals. The assessment of study quality and risk of bias was performed as per Cochrane collaboration

RESULTS: After screening from 4968 articles, 1926 articles were selected for review. Seven RCTs containing 18,762 patients were included in the final analysis after screening the 1926 articles. Analyses showed significant 36% risk reduction by Apixaban for the VTE, OR=0.64 [0.44, 0.94]. Risk reduction of 25% in major VTE was observed with Apixaban, OR=0.75 [0.44, 1.28]. Also, there was 3% decrease in the risk for major bleeding, OR=0.97 [0.50,1.86] and 8% reduction in Clinically Relevant Non-Major bleeding (CRNM) bleeding events, OR=0.92 [0.74, 1.15], with Apixaban in comparison with LMWH. Contrarily, there was 29% increase in the risk for the mortality with Apixaban, OR=1.29 [ 0.49, 3.37]. During quality assessment, two studies had high risk for the “blinding of participants and personnel” domain.

CONCLUSIONS: This meta-analysis concluded that Apixaban showed a superior efficacy over LMWH in terms of reduction of VTE and major VTE without increasing risk of bleeding.