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Comparative effectiveness of direct oral anticoagulants versus low-molecular weight heparins for the prevention of venous thromboembolism after total hip or knee replacement: A nationwide database cohort study

dc.rights.licenseopenen_US
dc.contributor.authorBLIN, Patrick
dc.contributor.authorSAMAMA, C. M.
dc.contributor.authorSAUTET, A.
dc.contributor.authorBENICHOU, J.
dc.contributor.authorLIGNOT-MALEYRAN, S.
dc.contributor.authorLAMARQUE, S.
dc.contributor.authorLORRAIN, S.
dc.contributor.authorLASSALLE, Regis
dc.contributor.authorDROZ-PERROTEAU, C.
dc.contributor.authorMISMETTI, P.
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorMOORE, Nicholas
dc.date.accessioned2020-05-20T08:08:15Z
dc.date.available2020-05-20T08:08:15Z
dc.date.issued2019
dc.identifier.issn1096-1186 (Electronic) 1043-6618 (Linking)en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/7641
dc.description.abstractEnBACKGROUND: Venous thromboembolism (VTE) after total knee or hip replacement (TKR, THR) is usually prevented with low-molecular weight heparin (LMWH), and increasingly by direct oral anticoagulants (DOAC). The aim of the present study was to compare the benefit-risk and medical costs of DOAC vs. LMWH in a real-life setting. METHODS: All patients with THR or TKR in France between Jan-1st 2013 and Sep-30th 2014, discharged to home, were identified and followed-up for 3 months in the French nationwide claims database, SNDS. DOAC users were 1:1 matched with LWMH users on gender, age and propensity score. Relative risks (RR) of hospitalized VTE, hospitalized bleeding and death were estimated using quasi-Poisson models. Medical costs were calculated according to the societal perspective, including total cost for outpatient claims and national DRG costs for hospitalisations. RESULTS: Most DOAC users (>/= 98.8%) were matched to a LMWH patient. For the 63,238 matched THR patients, the 3-month absolute risk of VTE was 0.9 per thousand with DOAC and 2.5 per thousand with LMWH (RR = 0.35 [0.23 to 0.54]), of bleeding 1.8 per thousand and 2.1 per thousand (0.88 [0.62-1.25]), death 0.7 per thousand and 1.1 per thousand (0.68 [0.40-1.15]). For the 31,440 matched TKR patients, risks were 1.6 per thousand and 2.3 per thousand (0.69 [0.42-1.16]) for VTE, 2.4 per thousand and 3.8 per thousand (0.64 [0.43 to 0.97]) for bleeding, and 0.6 per thousand and 0.8 per thousand (0.69 [0.30-1.62]) for all-cause death. Mean medical costs were 28% and 21% lower with DOAC than LMWH for THR and TKR, respectively. This nationwide study found a very low risk of VTE, hospitalized bleeding and death after THR or TKR discharge in patients with VTE prevention in real-life setting, with better benefit-risk profiles of DOAC compared to LMWH, and associated cost savings.
dc.language.isoENen_US
dc.subject.enPharmacoEpi-Drugs
dc.title.enComparative effectiveness of direct oral anticoagulants versus low-molecular weight heparins for the prevention of venous thromboembolism after total hip or knee replacement: A nationwide database cohort study
dc.title.alternativePharmacol Resen_US
dc.typeArticle de revueen_US
dc.identifier.doi10.1016/j.phrs.2018.12.018en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed30583081en_US
bordeaux.journalPharmacological Researchen_US
bordeaux.page201-207en_US
bordeaux.volume141en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.identifierhal-03209383
hal.version1
hal.date.transferred2021-04-28T01:50:50Z
hal.exporttrue
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