Safety and efficacy of switching from low molecular weight heparin to dabigatran in patients undergoing elective total hip or knee replacement surgery

Wurnig, Christian; Clemens, Andreas; Rauscher, Helmuth; Kleine, Eva; Feuring, Martin; Windhager, Reinhard; Grohs, Josef G.

doi:10.1186/s12959-015-0066-9

Cited by 5 publications

(3 citation statements)

References 32 publications

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“… 26 Two other studies evaluated the outcomes of a VTE protocol when switching from LMWH to dabigatran, which showed promising results. 27 , 28 However, all these studies had insufficient number of patients to extrapolate their findings to the general population, as opposed to this study, given the size of our patient sample.…”

Section: Discussionmentioning

confidence: 91%

Incidence of symptomatic venous thromboembolism in 2372 knee and hip replacement patients after discharge: data from a thromboprophylaxis registry in Montreal, Canada

Senay

Trottier

Delisle

et al. 2018

VHRM

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BackgroundLow-molecular-weight heparin (LMWH) is a recommended anticoagulant for thromboprophylaxis after major orthopedic surgery. Dabigatran etexilate is an oral anticoagulant recognized as noninferior to LMWH. We aimed to assess the incidence of symptomatic venous thromboembolic events (VTEs) after discharge in patients who underwent joint replacement, using a hospital registry.Patients and methodsPatients who underwent total knee and hip arthroplasty between September 2011 and March 2015 were selected. Subcutaneous enoxaparin (30 mg twice daily) was given during hospitalization. At discharge, patients received either enoxaparin 30 mg twice daily/40 mg once daily or dabigatran 220 mg/150 mg once daily. Patients were seen or called at 2, 6, and 12 weeks after surgery. Outcomes were the number of VTEs, including deep venous thrombosis, pulmonary embolism, and the number of major/minor bleeding events after discharge.ResultsAfter discharge, 1468 patients were prescribed enoxaparin and 904 dabigatran (1396 total knee arthroplasty and 976 total hip arthroplasty patients). Mean age was 66±10 years, and 60% were female. The cumulative incidence of VTEs during the 12-week follow-up was 0.7%. One patient sustained a VTE during the switch window. Seven patients sustained a pulmonary embolism (0.3%). There was no statistical difference between the total knee arthroplasty and total hip arthroplasty groups. The incidence of major and minor bleeding events during follow-up was 0.3% and 30.3%, respectively. These events had a higher incidence in the dabigatran group compared to the enoxaparin group after discharge (p<0.05), but not between knee and hip replacement groups for major bleeding events.ConclusionA pharmaceutical prophylaxis protocol using LMWH and dabigatran during the post-discharge period resulted in low incidences of VTE and equivalence between treatments. However, the increased number of major and minor bleeding events in patients taking dabigatran is of concern regarding the safety and needs to be evaluated using analyses adjusted for risk factors.

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Section: Discussionmentioning

confidence: 91%

Incidence of symptomatic venous thromboembolism in 2372 knee and hip replacement patients after discharge: data from a thromboprophylaxis registry in Montreal, Canada

Senay

Trottier

Delisle

et al. 2018

VHRM

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“…[ 26 ] Moreover, in 2015, Wurning et al proved that switching from LMWH to dabigatran was safe and effective for VTE prophylaxis after THA or TKA. [ 27 ]…”

Section: Direct Thrombin Inhibitorsmentioning

confidence: 99%

Role of Direct Oral Anticoagulants for Post-operative Venous Thromboembolism Prophylaxis

Tun

Kyaw²,

Rafflenbeul

et al. 2022

Eur Cardiol

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Venous thromboembolism (VTE) is one of the leading causes of post-operative morbidity and mortality. Over previous decades, heparin and warfarin were the predominant therapeutic options for post-operative thromboprophylaxis. However, their use is limited by drawbacks including a narrow therapeutic range, numerous food and drug interactions, and the need for regular monitoring for dose adjustments. Recently, direct oral anticoagulants (DOACs), such as dabigatran etexilate (a direct thrombin inhibitor) and apixaban, rivaroxaban and edoxaban (direct factor Xa inhibitors), have been developed to overcome these issues. DOACs have shown promising results in Phase III clinical trials for post-operative VTE prophylaxis. This review summarises the pharmacological profile of DOACs and highlights the use of DOACs in post-operative VTE prophylaxis based on the available clinical trial data.

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“…The authors concluded that switching patients from low-molecular-weight heparin to dabigatran is a safe and effective pharmacotherapy. In addition, switching from a subcutaneous to an oral therapy offered an easier, less expensive, and more convenient route of administration for the patients and healthcare professionals (21). As with the other NOA, the major concerns regarding the safety profile are the frequency and severity of bleeding.…”

Section: Dabigatranmentioning

confidence: 99%

Clinical and Economic Outcomes of New Oral Anticoagulants in Orthopaedics

Lakic

Travica

Odalović

et al. 2018

Serbian Journal of Experimental and Clinical Research

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Venous thromboembolism, including pulmonary embolism and deep vein thrombosis, is a significant factor in morbidity and mortality of patients. New oral anticoagulants, such as apixaban, dabigatran, and rivaroxaban, have recently demonstrated their safety and efficacy in patients undergoing major orthopaedic surgery. Selection of the appropriate drug should be adjusted according to patient needs. Major bleeding is rare with new oral anticoagulants and is comparable with the bleeding rate associated with low-molecular-weight heparins. Clinical data indicate that therapy with apixaban and rivaroxaban was more effective compared to enoxaparin, while dabigatran has a similar efficacy to enoxaparin. Cost-effectiveness studies of new oral anticoagulants showed that these medicines offer higher efficacy with acceptable costs for the healthcare system, even saving costs in certain cases. Clinical practice in Serbia reflects considerably more frequent use of traditional anticoagulant medication therapy compared to new oral anticoagulants.

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Safety and efficacy of switching from low molecular weight heparin to dabigatran in patients undergoing elective total hip or knee replacement surgery

Cited by 5 publications

References 32 publications

Incidence of symptomatic venous thromboembolism in 2372 knee and hip replacement patients after discharge: data from a thromboprophylaxis registry in Montreal, Canada

Incidence of symptomatic venous thromboembolism in 2372 knee and hip replacement patients after discharge: data from a thromboprophylaxis registry in Montreal, Canada

Role of Direct Oral Anticoagulants for Post-operative Venous Thromboembolism Prophylaxis

Clinical and Economic Outcomes of New Oral Anticoagulants in Orthopaedics

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