Benefits of novel oral anticoagulant agents for thromboprophylaxis after total hip or knee arthroplasty.

BACKGROUND: The incidence of venous thromboembolism (VTE) after total hip arthroplasty (THA) or total knee arthroplasty (TKA) is reduced by the use of thromboprophylactics, such as vitamin K antagonists, low-molecular-weight heparin (LMWH), or fondaparinux. However, these agents have a number of limitations that constrain their use and increase the clinical and economic burden on patients, caregivers, and healthcare resources. Effective prophylaxis may also be complicated by poor adherence to guideline recommendations.
OBJECTIVE: This article reviews the potential of newly developed oral anticoagulants to address many of the management challenges associated with vitamin K antagonists, LMWHs, and fondaparinux. DISCUSSION: The 3 oral anticoagulants rivaroxaban, apixaban, and dabigatran have been evaluated in large phase 3 trials, and all 3 represent promising alternatives to the current standard of care. Currently, rivaroxaban is the only new oral agent to have received US Food and Drug Administration approval in the United States for prophylaxis of deep-vein thrombosis, which may lead to pulmonary embolism in patients undergoing THA or TKA. The simplified management of the new oral agents may encourage adherence with published guidelines for VTE prophylaxis and help to reduce the economic burden of VTE. Pharmacoeconomic data suggest that rivaroxaban and dabigatran may result in cost-savings when compared with enoxaparin after THA or TKA.
CONCLUSIONS: The numbers of THA and TKA surgeries are expected to increase significantly in coming years, and safer and more effective thromboprophylaxis is essential to mitigate the morbidity and mortality associated with VTE. Newly developed oral anticoagulants have the potential to address many of the limitations of current thromboprophylaxis and may reduce the cost burden associated with the management of VTE after THA or TKA.