Key result
Enoxaparin and heparin dominate post-arthroplasty thromboprophylaxis with a ~1% 12-month VTE incidence.
Why the study?
Venous thromboembolism is a common complication after total hip or knee replacement, and real-world data on thromboprophylaxis drug utilization and treatment costs are needed.
Cohort (n=10,389)
Yes
In real-world practice, enoxaparin and heparin are the most commonly used thromboprophylaxis agents following total hip or knee replacement, with a low incidence of VTE during 12-month follow-up.
Real-world thromboprophylaxis patterns and costs post-THR/TKR vary widely; leaves open optimal regimen selection and adherence impact.
INTRODUCTION: Venous thromboembolism (VTE) is a well-known complication of total hip replacement (THR) and total knee replacement (TKR). Various drugs have been introduced in an attempt to reduce the mortality as well as the short-term and long-term morbidity associated with the development of VTE. The aim of this study was to analyze drug utilization for thromboprophylaxis and the cost of illness in real clinical practice in patients with THR or TKR. MATERIALS AND METHODS: A multicenter, retrospective, observational cohort study based on local health unit administrative databases was conducted. All patients (≥18 years old) discharged for THR/TKR procedures between January 1, 2007 and December 31, 2008 were included in the study. The date of first hospital discharge was the index date; patients were followed up for a period of 12 months. RESULTS: A total of 10,389 patients were included: 3516 males (33.8%, 69.4 ± 10.4 years) and 6873 females (66.2%, 71.7 ± 9.0 years), of which 5483 (52.8%) were discharged for THR and 4906 (47.2%) for TKR. First antithrombotic treatments after discharge were enoxaparin (3937, 37.9%), heparin (3752, 36.1%), antiplatelet agents (658, 6.3%), vitamin K antagonists (276, 2.7%), fondaparinux (136, 1.3%), combinations (185, 1.8%), and no therapy (1445, 13.9%). Overall, we observed 2347 (22.6%) treatment changes; median duration of antithrombotic treatment was 23 days (range 11-47) for THR and 22 days (range 11-46) for TKR. During the follow-up period, we observed 129 cases of VTE (120 per 10,000 patients), five post-thrombotic syndrome (4.8 per 10,000 patients), and three heparin-induced thrombocytopenia (2.9 per 10,000 patients). Median cost for both THR and TKR was €9052.00 (range €8063.00-€9084.96), with a median length of stay of 9.0 days (range 6.0-12.0).
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Esposti et al. (2012) conducted a cohort in Total hip or knee replacement (n=10,389). Antithrombotic treatments was evaluated on Drug utilization, VTE incidence, and cost of illness. Among 10,389 patients undergoing total hip or knee replacement, enoxaparin (37.9%) and heparin (36.1%) were the most common antithrombotics, with a 1.2% incidence of VTE over 12 months.
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