Economic Impact of Venous Thromboembolism After Hip and Knee Arthroplasty

Potential Impact of Rivaroxaban

Richard J Friedman; Nishan Sengupta; Michael Lees

Disclosures

Expert Rev Pharmacoeconomics Outcomes Res. 2011;11(3):299-306. 

In This Article

Compliance with Anti-thrombotic Guidelines

Despite the guidelines, many patients do not receive effective prophylaxis;[21] one study found that fewer than one in five elderly patients received post-discharge thromboprophylaxis after THA or TKA.[22] Analysis of the Global Orthopaedic Registry (GLORY) found that whereas almost all THA patients received a form of prophylaxis, only 47% of patients received prophylaxis in compliance with ACCP guidelines in terms of type, duration, start time and dose.[23] There are a number of possible reasons for this lack of adherence, including concerns about the risks of prophylaxis.[24–26] However, there is little evidence that prophylaxis causes surgical bleeding or that bleeding after arthroplasty compromises the short- or long-term outcomes.[27] In fact, the rate of major bleeding after major knee surgery was found to be similar in patients who received LMWH or placebo (2.5 vs 2.4%).[28] Another potential barrier to the optimal use of thromboprophylaxis could be the inconvenience of sc. administration or coagulation monitoring[29] and overall costs associated with currently available agents,[30,31] particularly in light of recommendations for extended post-discharge thromboprophylaxis. The ideal regimen for an anticoagulant for optimal convenience would be once-daily (q.d.) oral provision,[30] which may also facilitate compliance.[32]

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