6/28/23, 12:03 AM ADVANCE (apixaban) Pathway Feedback Search Clinical Topics Home Studies ADVANCE (apixaban) ADVANCE (apixaban) Disease Hip osteoarthritis Trial question What is the role of apixaban for thromboprophylaxis in patients undergoing hip replacement? Study design Multi-center Double blinded RCT Population Characteristics of study participants 53.0% female N = 5407 47.0% male 5407 patients (2881 female, 2526 male) Inclusion criteria: patients undergoing total hip replacement Key exclusion criteria: active bleeding, a contraindication to anticoagulant prophylaxis, or the need for ongoing anticoagulant or antiplatelet treatment Interventions N=1949 apixaban (2.5 mg PO BID for 35 days after surgery) N=1917 enoxaparin (40 mg SC every 24 hours for 35 days after surgery) Primary outcome Deep venous thrombosis, nonfatal pulmonary embolism, or death from any cause 3.9 % 3.9 https://web.pathway.md/studies/recvZcFYVD0URG0CL 1/2 6/28/23, 12:03 AM ADVANCE (apixaban) Pathway 3 9 2.9 % 1.9 % Significant decrease 1.4 1.0 % NNT = 40 0.0 % Apixaban Enoxaparin Significant decrease in DVT, nonfatal PE, or death from any cause (1.4% vs. 3.9%; RR 0.36, 95% CI 0.22 to 0.54) Secondary outcomes No significant difference in major and clinically relevant nonmajor bleeding (4.8% vs. 5%; ARD -0.2, 95% CI -1.4 to 1) Significant decrease in major VTE (0.5% vs. 1.1%; RR 0.4, 95% CI 0.15 to 0.8) No significant difference in all bleeding events (11.7% vs. 12.6%; ARD -0.9, 95% CI -2.6 to 0.9) Safety outcomes No significant differences in major bleeding event, clinically relevant nonmajor bleeding, minor bleeding events. Conclusion In patients undergoing total hip replacement, apixaban was superior to enoxaparin with respect to DVT, nonfatal PE, or death from any cause. Reference ADVANCE Collaborative Group, Patel A, MacMahon S et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008 Jun 12;358(24):2560-72. Open reference URL https://web.pathway.md/studies/recvZcFYVD0URG0CL 2/2