Clinical and economic outcomes of new oral anticoagulants in orthopaedics

Abstract

Venous thromboembolism, including pulmonary embolism and deep vein thrombosis, is a signifi cant factor in morbidity and mortality of patients. New oral anticoagulants, such as apixaban, dabigatran, and rivaroxaban, have recently demonstrated their safety and efficacy in patients undergoing major orthopaedic surgery. Selection of the appropriate drug should be adjusted according to patient needs. Major bleeding is rare with new oral anticoagulants and is comparable with the bleeding rate associated with low-molecular-weight heparins. Clinical data indicate that therapy with apixaban and rivaroxaban was more effective compared to enoxaparin, while dabigatran has a similar efficacy to enoxaparin. Cost-effectiveness studies of new oral anticoagulants showed that these medicines offer higher efficacy with acceptable costs for the healthcare system, even saving costs in certain cases. Clinical practice in Serbia reflects considerably more frequent use of traditional anticoagulant medication therapy compared to new oral anticoagulants.

Venska tromboembolija, koja uključuje plućnu emboliju i duboku vensku trombozu, predstavlja značajan faktor morbiditeta i mortaliteta pacijenata. Novi oralni antikoagulansi, poput apiksabana, dabigatrana i rivaroksabana, su nedavno pokazali svoju bezbednost i efikasnost kod pacijenata koji se podvrgavaju velikim ortopedskim intervencijama. Izbor odgovarajućeg leka treba prilagoditi individualnim potrebama pacijenta. Velika krvarenja su relativno retka u toku primene novih oralnih antikoagulanasa i uporedivi su sa stopom krvarenja prilikom primene nisko-molekularnih heparina. Klinički podaci ukazuju da je terapija apiksabanom i rivarokabanom efikasnija u odnosu na enoksaparin, dok dabigatran ima slične efekte kao enoksaparin. Troškovna isplativost novih oralnih antikoagulanasa potvrđuje veću efikasnost sa prihvatljivim troškovima za zdravstveni sistem, u nekim slučajevima čak i sa uštedama.