5-ht3 receptor antagonist Bicalutamide Was Simply Too Easy Before, These Days It Is Practically Impossible

ompleted, 5-ht3 receptor antagonist along with the outcomes had been reported at the 15thCongress of the European Hematology Association held inJune 2010. In this double-blind, non-inferiority trial, patientsundergoing total hip arthroplasty had been randomizedto obtain either oral dabigatran etexilate, 220 mg when daily,or subcutaneous enoxaparin, 40 mg when daily, for 28–35 days. Dabigatran etexilate demonstrated non-inferiorityto enoxaparin for the principal efficacy outcome, a compositeof total VTE and all-cause mortality, which occurred in 7.7%of the dabigatran etexilate group versus 8.8%of the enoxaparin group. Significant bleedingrates had been comparable in both groups and occurred in1.4% of the dabigatran etexilate group and 0.9% of theenoxaparin group. Adverse events did not differ significantlybetween the two groups.
The study concludedthat oral dabigatran etexilate, 220 mg when daily, was aseffective as subcutaneous enoxaparin, 40 mg when daily, inreducing the VTE risk immediately after total hip arthroplasty, withsimilar safety profiles and bleeding risk.RivaroxabanAs part of the RECORD clinical programme beingundertaken by Bayer Schering Pharma AG, four phase IIIclinical trials happen to be completed 5-ht3 receptor antagonist and published on theefficacy and safety of rivaroxaban for the principal preventionof VTE following hip and knee arthroplasty. Of certain note is that the incidence of surgicalsite bleeding was not included within the bleeding data for theRECORD trials, which resulted in lower overall rates ofbleeding compared with clinical trials of other thromboprophylacticagents such as dabigatran etexilate.
The RECORD1 trial randomized 4,541 patients undergoingtotal hip replacement surgery to obtain eitherrivaroxaban, 10 mgonce daily, or subcutaneousenoxaparin, 40 mgonce daily, Bicalutamide for 35 days.Considerably fewer patients within the rivaroxaban groupexperienced a principal efficacy outcomeevent of deep vein thrombosis, non-fatal pulmonaryembolism or death from any trigger at 36 days, comparedwith patients within the enoxaparin group. There was no considerable difference betweenthe two groups within the rate of major bleeding.Similarly, the RECORD2 trial that was also undertakenin hip replacement patientsdemonstrated superiorefficacy for rivaroxaban compared with enoxaparin forthe exact same principal outcome composite, although it should benoted that rivaroxaban was administered for a longer periodof time than enoxaparin. The major bleeding rates wereidentical for the two groups.
Two studies, RECORD3and RECORD4, wereundertaken in patients undergoing total knee replacementsurgery. RECORD3 randomized 2,531 patients to receiveeither rivaroxaban, 10 NSCLC mgonce daily, or subcutaneousenoxaparin, 40 mgonce daily, for 10–14 days. In contrast, RECORD4 compared rivaroxaban,10 mgonce daily, with all the North American doseof enoxaparin. Bothstudies demonstrated considerably fewer principal outcomeeventswith rivaroxabancompared with enoxaparinand comparable rates ofmajor bleeding.In summary, when daily oral rivaroxabanwassignificantly much more efficient than subcutaneous enoxaparinat preventingVTE-related events immediately after either elective hip or kneereplacement surgery.
There was no considerable increase inthe rate of major bleeding among rivaroxaban andenoxaparin, but surgical web-site bleeds had been not included inthe safety Bicalutamide outcome evaluation, and it's known from otherstudies that these contribute considerably to the total majorbleeding rate. Bleeding into the surgical web-site is ofclinical significance to orthopaedic surgeons because of thenegative impact it may have on the risk of wound infectionand the want for reoperation of the prosthetic joint.ApixabanThe ADVANCE clinical programme, which is beingcoordinated by Bristol–Myers Squibb and Pfizer, isevaluating the thromboprophylactic efficacy and safety ofapixaban inside a range of indications. Two phase III clinicaltrials that have been undertaken in orthopaedic patientshave been published to date: the ADVANCE-1 andADVANCE-2 studies in patients undergoing total kneereplacement.
Similar to the dabigatran etexilatetrials, these studies 5-ht3 receptor antagonist included bleeding at the surgical web-site intheir safety analyses. The ADVANCE-1 study compared10–14 days of treatment with apixabanwith enoxaparin Bicalutamide at the North American dosein 3,195 patients, and failed to show non-inferiorityfor apixaban for the composite principal efficacy outcome oftotal VTE events and all-cause mortality. Thiswas due to the fact the incidence of the composite primaryefficacy outcome in patients treated with enoxaparin wasonly 55% of the predicted rate that was utilized to establish thecriteria for non-inferiority and to calculate the sample size. Apixaban treatment was associated with fewer majorbleeding events than enoxaparin. In contrast, the subsequentADVANCE-2 study in 3,057 patients demonstrated superiorefficacy for apixabancomparedwith enoxaparin utilized at the EU doseforthe exact same principal efficacy composite outcome. Furthermore,there was no considerable difference within the rate of majorbleedingandthe rate of the composite of major bleeding and clinicallyrelevant