| dc.description.abstract | Abstract
Introduction:
Venous thromboembolism (VTE) is a common and potentially lethal complication after total hip
arthroplasty (THA). While low molecular weight heparin (LMWH) remains the gold standard
antithrombotic medication after THA in Nordic countries, recent randomized trials have
demonstrated superior efficacy in new oral anticoagulants (NOAC) such as dabigatran and
rivaroxaban compared to LMWH. In this register study we compared established efficacy and
safety outcomes between patients who had received LMWH and NOAC as thromboprophylaxis
after THA.
Method:
Data was collected from the Swedish Hip Arthroplasty Register (SHAR), the National Patient
Register (NPR) and the Prescribed Drug Register (PDR) to form a database from which 32633
patients were selected. These included all primary THA procedures for patients with
osteoarthritis. Patients who had an earlier VTE diagnosis or received a potent anticoagulant were
excluded from the analysis. A binary logistic regression model adjusted for age, sex and previous
antiaggregant medication was used to calculate odds ratios (OR) for VTE-incidence up till 3
months after surgery.
Results:
26881 patients received LMWH and 5752 patients were treated with NOAC. The VTE-incidence
in the LMWH group was 1.0% (n=264) and 0.4% (n=24) in the NOAC group. Adjusted OR for
VTE was 0.42 (95% CI: 0.28-0.64, p<0.0001); deep venous thrombosis (DVT) 0.46 (95% CI:
0.28-0.76, p=0.002); pulmonary embolism (PE) 0.34 (95% CI:0.17-0.71, p=0.004); major
bleeding events 0.96 (95% CI: 0.72-1.27, p=0.756); and minor bleeding events 0.75 (95% CI:
0.32-1.79, p=0.521) in the NOAC group.
Conclusion:
The incidence of VTE following THA was lower for patients with NOAC compared to those
with LMWH as thromboprophylactic medication. There were no differences in adverse events
including bleeding, reoperation and death. Similar, but less pronounced differences have been
reported previously. Although, there may be residual confounding due to selection bias the
magnitude of the difference warrants a call for change of practice.
Abbreviations
THA Total hip arthroplasty
TKA Total knee arthroplasty
VTE Venous thromboembolism
DVT Deep venous thrombosis
PE Pulmonary embolism
SHAR Swedish Hip Arthroplasty Register
PDR Prescribed Drug Register
NPR National Patient Register
LMWH Low molecular weight heparin
NOAC New oral anticoagulants
OR Odds ratio
CI Confidence interval
BMI Body mass index
ASA American Society of Anesthesiologists | sv |
