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.license | open | en_US |
| dc.contributor.author | BLIN, Patrick | |
| dc.contributor.author | SAMAMA, C. M. | |
| dc.contributor.author | SAUTET, A. | |
| dc.contributor.author | BENICHOU, J. | |
| dc.contributor.author | LIGNOT-MALEYRAN, S. | |
| dc.contributor.author | LAMARQUE, S. | |
| dc.contributor.author | LORRAIN, S. | |
| dc.contributor.author | LASSALLE, Regis | |
| dc.contributor.author | DROZ-PERROTEAU, C. | |
| dc.contributor.author | MISMETTI, P. | |
| hal.structure.identifier | Bordeaux population health [BPH] | |
| dc.contributor.author | MOORE, Nicholas | |
| dc.date.accessioned | 2020-05-20T08:08:15Z | |
| dc.date.available | 2020-05-20T08:08:15Z | |
| dc.date.issued | 2019 | |
| dc.identifier.issn | 1096-1186 (Electronic) 1043-6618 (Linking) | en_US |
| dc.identifier.uri | https://oskar-bordeaux.fr/handle/20.500.12278/7641 | |
| dc.description.abstractEn | BACKGROUND: 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.iso | EN | en_US |
| dc.subject.en | PharmacoEpi-Drugs | |
| dc.title.en | 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.title.alternative | Pharmacol Res | en_US |
| dc.type | Article de revue | en_US |
| dc.identifier.doi | 10.1016/j.phrs.2018.12.018 | en_US |
| dc.subject.hal | Sciences du Vivant [q-bio]/Santé publique et épidémiologie | en_US |
| dc.identifier.pubmed | 30583081 | en_US |
| bordeaux.journal | Pharmacological Research | en_US |
| bordeaux.page | 201-207 | en_US |
| bordeaux.volume | 141 | en_US |
| bordeaux.hal.laboratories | Bordeaux Population Health Research Center (BPH) - U1219 | en_US |
| bordeaux.institution | Université de Bordeaux | en_US |
| bordeaux.peerReviewed | oui | en_US |
| bordeaux.inpress | non | en_US |
| hal.identifier | hal-03209383 | |
| hal.version | 1 | |
| hal.date.transferred | 2021-04-28T01:50:50Z | |
| hal.export | true | |
| bordeaux.COinS | ctx_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.jtitle=Pharmacological%20Research&rft.date=2019&rft.volume=141&rft.spage=201-207&rft.epage=201-207&rft.eissn=1096-1186%20(Electronic)%201043-6618%20(Linking)&rft.issn=1096-1186%20(Electronic)%201043-6618%20(Linking)&rft.au=BLIN,%20Patrick&SAMAMA,%20C.%20M.&SAUTET,%20A.&BENICHOU,%20J.&LIGNOT-MALEYRAN,%20S.&rft.genre=article |
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