Published Online: March 10, 2011
Geno Merli, MD, FACP, FHM, FSVM
The new anticoagulants, with their oral route of administration and no requirement for coagulation monitoring, will simplify the management of thromboprophylaxis. Their convenience and lack of interaction with food and with other drugs should improve patient adherence to therapy, resulting in a reduced incidence of deep vein thrombosis and pulmonary embolism in patients after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The improved efficacy of rivaroxaban compared with the current standard of care for in-hospital prophylaxis, enoxaparin, should also mean fewer embolic events, and should result in cost savings and improved quality of life after THA/TKA.1 The new national and local strategies to increase appropriate use of thromboprophylaxis whenever appropriate2,3 should also produce substantial reductions in in-hospital vascular embolic events. These reductions in events should translate into reductions in long-term complications, with further cost savings4 and a reduction in the burden of disease for patients.5-7
This supplement has highlighted the changes that will probably occur once the new anticoagulants are used to prevent venous thrombosis after THA and TKA. If these agents do prove to be cost-effective, they will be responsible for dramatically reducing the burgeoning economic burden on the healthcare system-particularly due to venous thromboembolism following total joint replacement surgery. Compared with 2005 values, the annual numbers of procedures in the United States are predicted to rise from 285,000 to 572,000 THAs and from 523,000 to 3,480,000 TKAs by 2030.8 Therefore, even modest reductions in cost compared with those associated with the use of current anticoagulants would translate into significant savings with an important impact on the allocation of healthcare resources. In recent technology appraisals of rivaroxaban9 and dabigatran,10 both were found to be associated with an increase in quality-adjusted life-years, so the new anticoagulants should also reduce the burden of illness for patients. While these observations remain speculative at this time, recent clinical trial results with these promising new agents provide great cause for optimism.
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