Economic Evaluations Of New Oral Anticoagulants For The Prevention Of Venous Thromboembolism After Total Hip Or Total Knee Replacement

INTRODUCTION Because of the high risk of venous thromboembolism (VTE) in total hip replacement (THR) and total knee replacement (TKR), guidelines are used widely to enhance effective (yet safe) prophylaxis. If patients develop VTEs despite use of such guidelines, then the reasons are that the guidelines were: (i) followed but the VTE occurred anyway; (ii) not implemented appropriately. All VTEs are assessed routinely by root-cause analysis (RCA). METHODS The records and subsequent RCA reports for each patient who experienced clinically significant VTE after THR or TKR were reviewed. We established adherence to the guidelines (deemed to be ‘unavoidable’ with scope to improve the guidelines) and non-adherence (deemed to be ‘avoidable’ with scope to improve implementation). RESULTS Of 2,214 patients undergoing THR (n=1,330) or TKR (n=884), 25 (1.13%) experienced VTE. Four THR patients experienced VTE (2 of which were avoidable) and 21 TKR patients experienced VTE (5 of which were avoidable). There were significantly more VTEs in TKR patients than THR patients (p<0.0001). CONCLUSIONS A proportion of patients will experience VTE even if guidelines are followed (a baseline effect). Administration of chemical prophylaxis earlier might reduce this baseline effect further. This approach should be taken cautiously with due respect for the alternative risk of bleeding. Improvement in hospital routine may reduce the risk of VTE yet further.

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Economic Evaluation of Rivaroxaban Versus Enoxaparin for Prevention of Venous Thromboembolism After Total Knee Replacement and Total Hip Replacement: A Systematic Review

Clinical Drug Investigation ◽

10.1007/s40261-020-00940-4 ◽

2020 ◽

Vol 40 (8) ◽

pp. 715-725 ◽

Cited By ~ 1

Author(s):

Asma Rashki Kemmak ◽

Ali Abutorabi ◽

Vahid Alipour

Keyword(s):

Systematic Review ◽

Economic Evaluation ◽

Venous Thromboembolism ◽

Total Knee Replacement ◽

Total Hip Replacement ◽

Knee Replacement ◽

Hip Replacement ◽

Total Hip ◽

Total Knee

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Safety of apixaban in Indian patients undergoing elective total knee replacement or total hip replacement surgery: A multi-center, phase-IV study

SAGE Open Medicine ◽

10.1177/20503121211049962 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110499

Author(s):

Himanshu Panchal ◽

Abhijit Agashe ◽

Parag K Sancheti ◽

Namrata B Kulkarni ◽

Santosh R Taur

Keyword(s):

Venous Thromboembolism ◽

Total Knee Replacement ◽

Total Hip Replacement ◽

Knee Replacement ◽

Major Bleeding ◽

Hip Replacement ◽

Total Hip ◽

Indian Patients ◽

Total Knee ◽

Phase Iv

Background: Venous thromboembolism is a significant source of morbidity and mortality following total hip replacement and total knee replacement. Apixaban has been proven to be efficacious without increased risk of bleeding in phase-III trials in patients undergoing total knee replacement and total hip replacement. Due to paucity of data on safety of apixaban in Indian patients, this phase-IV study was conducted to evaluate safety of apixaban in patients undergoing total knee replacement and total hip replacement. Methods: In this non-comparative phase-IV clinical trial, patients undergoing elective total knee replacement or total hip replacement surgery, or a revision of at least one component of total knee replacement or total hip replacement, were enrolled. The eligible patients were given the approved dosage of apixaban 12 to 24 h after completing the skin wound closure. The primary safety outcome was the composite of the International Society on Thrombosis and Haemostasis–defined major bleeding and clinically relevant non-major bleeding events at the end of the treatment. The secondary efficacy endpoint was the composite of venous thromboembolism/all-cause death at the end of the treatment. Results: A total of 498 patients received apixaban prophylaxis therapy. Six (1.2%) bleeding adverse events were observed during the treatment period. Only one bleeding event was adjudicated as an International Society on Thrombosis and Haemostasis–defined clinically relevant non-major bleeding event (moderate severity). There were no fatal bleeding events and no deaths following the treatment. One venous thromboembolism event, that is, symptomatic distal left leg DVT, was reported in a total knee replacement patient and was adjudicated during the treatment period. Conclusion: Apixaban demonstrated a favorable safety profile for venous thromboembolism prevention in Indian patients undergoing total knee replacement or total hip replacement.

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The Efficacy and Safety of Rivaroxaban for Venous Thromboembolism Prophylaxis after Total Hip and Total Knee Arthroplasty

Thrombosis ◽

10.1155/2013/762310 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 11

Author(s):

Robert D. Russell ◽

William R. Hotchkiss ◽

Justin R. Knight ◽

Michael H. Huo

Keyword(s):

Total Knee Arthroplasty ◽

Venous Thromboembolism ◽

Knee Arthroplasty ◽

Oral Anticoagulants ◽

New Oral Anticoagulants ◽

Efficacy And Safety ◽

Vte Prophylaxis ◽

Total Hip ◽

Increased Risk ◽

Total Knee

Venous thromboembolism (VTE) is a common complication after total hip and total knee arthroplasty. Currently used methods of VTE prophylaxis after these procedures have important limitations, including parenteral administration, and unpredictable plasma levels requiring frequent monitoring and dose adjustment leading to decreased patient compliance with recommended guidelines. New oral anticoagulants have been demonstrated in clinical trials to be equally efficacious to enoxaparin and allow for fixed dosing without the need for monitoring. Rivaroxaban is one of the new oral anticoagulants and is a direct factor Xa inhibitor that has demonstrated superior efficacy to that of enoxaparin. However, the data also suggest that rivaroxaban has an increased risk of bleeding compared to enoxaparin. This paper reviews the available data on the efficacy and safety of rivaroxaban for VTE prophylaxis after total hip and total knee arthroplasty.

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