Pharmacoeconomic implications of thromboprophylaxis with new oral anticoagulants after total hip or knee replacement in the USA

2013 ◽  
Vol 14 (4) ◽  
pp. 525-534 ◽  
Author(s):  
Edith A Nutescu
Keyword(s):  
Knee Replacement ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Total Hip ◽  
The Usa

Comparative Effectiveness of New Oral Anticoagulants and Standard Thromboprophylaxis in Patients Having Total Hip or Knee Replacement

2013 ◽  
Vol 159 (4) ◽  
pp. 275 ◽  
Author(s):  
Soheir S. Adam ◽  
Jennifer R. McDuffie ◽  
Paul F. Lachiewicz ◽  
Thomas L. Ortel ◽  
John W. Williams
Keyword(s):  
Knee Replacement ◽  
Comparative Effectiveness ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Total Hip

scholarly journals Efficacy and Safety of Enoxaparin versus New Oral Anticoagulants to Prevent Venous Thromboembolism after Total Hip Replacement: A Systematic Review and Meta-Analysis

2022 ◽  
Vol 12 (1) ◽  
pp. 107
Author(s):  
Mohammed Farhan A Alfarhan
Keyword(s):  
Systematic Review ◽  
Venous Thromboembolism ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
New Oral Anticoagulants ◽  
Clinical Endpoint ◽  
Efficacy And Safety ◽  
Total Hip

Prophylactic anticoagulant therapy is recommended for reducing the risk of venous thromboembolism (VTE) after a total hip replacement (THR). However, it is not clear which anticoagulant is preferable. Hence, a systematic review and meta-analysis of randomized double-blind controlled trials (RDBCTs) were conducted to investigate the clinical efficacy and safety of enoxaparin in comparison with newer oral anticoagulants for the prevention of VTE after THR. The Cochrane Library, Scopus, Web of Science, Embase, and PubMed/Medline databases were used for PICO search strategy. Relative risks (RR) of symptomatic VTE, clinically relevant bleeding, mortality, and a net clinical endpoint were estimated employing a random effect meta-analysis. ITC and RevMan software were used for indirect and direct comparisons, respectively. Nine RDBCTs comprising 24,584 patients were included. As compared to enoxaparin, a reduced risk for symptomatic VTE was observed with rivaroxaban (confidence interval [CI]: 0.32–0.77; RR: 0.46%) and comparable with apixaban (0.12–1.26; 0.42%) and dabigatran (0.22–2.20; 0.70%). Contrarily to enoxaparin, a greater risk for clinically relevant bleeding was observed with rivaroxaban (1.03–1.48; 1.23%), comparable with dabigatran (0.96–1.33; 1.10%) and reduced with apixaban (0.19–5.66; 0.96%). In indirect or direct comparisons, the interventions did not differ on the net clinical endpoint. In conclusion, the findings of this meta-analysis revealed no significant difference in the efficacy and safety of new oral anticoagulants as compared to enoxaparin for the prevention of VTE after total hip replacement surgery.

scholarly journals NEW ANTICOAGULANTS AS THROMBOPROPHYLAXIS AFTER TOTAL HIP OR KNEE REPLACEMENT

2013 ◽  
Vol 29 (3) ◽  
pp. 234-243 ◽  
Author(s):  
Vida Hamidi ◽  
Tove Ringerike ◽  
Gunhild Hagen ◽  
Åsmund Reikvam ◽  
Marianne Klemp
Keyword(s):  
Cost Effectiveness ◽  
Knee Replacement ◽  
Clinical Efficacy ◽  
Oral Anticoagulants ◽  
Cost Effective ◽  
Efficacy And Safety ◽  
Total Hip ◽  
Increased Risk ◽  
Major Orthopedic Surgery ◽  
Safety Outcomes

Objectives: Due to a high risk of thromboembolism in patients undergoing major orthopedic surgery, it has become standard practice to give thromboprophylactic treatment. We assessed the relative efficacy and cost-effectiveness of two new oral anticoagulants, rivaroxaban and dabigatran, relative to subcutaneous enoxaparin for the prevention of thromboembolism after total hip replacement (THR) and total knee replacement surgery (TKR).Methods: We conducted a systematic review of the literature to assess efficacy and safety, and evaluated quality of documentation using GRADE. Cost-effectiveness was assessed by developing a decision model. The model combined two modules; a decision tree for the short-term prophylaxis and a Markov model for the long-term complications and survival gain.Results: For rivaroxaban compared with enoxaparin, we found statistically significant decreases in deep vein thrombosis, but also a trend toward increased risk of major bleeding. For mortality and pulmonary embolism there were no statistically significant differences between the treatments. We did not find statistically significant differences between dabigatran and enoxaparin for our efficacy and safety outcomes. Assuming a willingness to pay of EUR62,500 per QALY, rivaroxaban following THR had a probability of 38 percent, and enoxaparin following TKR had a probability of 34 percent of being cost-effective. Clinical efficacy had the greatest impact on decision uncertainty.Conclusions: Dabigatran and rivaroxaban are comparable with enoxaparin following THR and TKR regarding the efficacy and safety outcomes. However, there is great uncertainty regarding which strategy is the most cost-effective. More research on clinical efficacy of rivaroxaban and dabigatran is likely to change our results.

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