Key result
Dabigatran etexilate administered for thromboprophylaxis after hip or knee replacement in a real-world setting demonstrated a 1.04% incidence of symptomatic VTE and all-cause mortality, and a 0.72% incidence of major bleeding.
Why the study?
Does dabigatran etexilate 220 mg once daily safely and effectively prevent symptomatic VTE and all-cause mortality in patients undergoing total hip or knee replacement in a real-world setting?
Observational (n=5,292)
Open-label
Yes
Does dabigatran etexilate 220 mg once daily safely and effectively prevent symptomatic VTE and all-cause mortality in patients undergoing total hip or knee replacement in a real-world setting?
In a real-world setting, dabigatran etexilate 220 mg once daily for thromboprophylaxis after hip or knee replacement showed low rates of major bleeding and symptomatic VTE, consistent with phase 3 trial results.
Real-world data support dabigatran thromboprophylaxis after arthroplasty; leaves open need for confirmatory randomized trials.
BACKGROUND: Thromboprophylaxis is recommended for patients undergoing total hip or total knee replacement (THR, TKR). An international, open-label, prospective, observational, single-arm study in a routine clinical setting was performed to assess the safety and efficacy of dabigatran etexilate 220 mg once daily in patients undergoing THR or TKR, and in subgroups of patients with potentially increased risk of bleeding or venous thromboembolism (VTE). MATERIALS AND METHODS: Patients were ≥18 years and required to be eligible to receive dabigatran 220 mg once daily (first dose 110 mg 1-4 h after THR/TKR surgery) according to the European Summary of Product Characteristics. The primary safety and efficacy outcomes were incidence of major bleeding events (MBEs), and the composite incidence of symptomatic VTE events and all-cause mortality, respectively. RESULTS: In total, 5292 patients (median age 64 years) were enrolled and received dabigatran (2734 THR and 2558 TKR). Median drug exposure was 31 days (THR 34 days; TKR 27 days). Overall incidence of MBEs was 0.72 % (95 % confidence interval [CI] 0.51, 0.98), and this rate was comparable between types of surgery and was not significantly affected by protocol-defined risk factors. The overall incidence of symptomatic VTE and all-cause mortality was 1.04 % (95 % CI 0.78, 1.35); the only significant risk factor was history of VTE events (odds ratio 5.59; 95 % CI 2.53, 11.08). A post-hoc analysis showed that the incidence of MBEs in this observational study was similar to or lower than those reported in previous phase 3 trials. CONCLUSIONS: Results from this observational study of dabigatran etexilate administered to patients undergoing THR or TKR surgery are reassuring and supportive of those obtained in dabigatran phase 3 trials. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00846807.
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Rosencher et al. (2016) conducted an observational in Elective total hip or total knee replacement (n=5,292). Dabigatran etexilate was evaluated on Composite of symptomatic VTE and all-cause mortality (95% CI 0.78, 1.35). Dabigatran etexilate administered for thromboprophylaxis after hip or knee replacement in a real-world setting demonstrated a 1.04% incidence of symptomatic VTE and all-cause mortality, and a 0.72% incidence of major bleeding.
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