New oral anticoagulants for thromboprophylaxis in patients having hip or knee arthroplastyBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.c7270 (Published 18 January 2011) Cite this as: BMJ 2011;342:c7270
- John W Eikelboom, associate professor 1,
- Jeffrey I Weitz, professor2, executive director3
- 1Department of Medicine, McMaster University, Hamilton, ON, Canada L8S 4K1
- 2Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada L8S 4K1
- 3Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton
- Correspondence to: J Eikelboom
The newest oral anticoagulants, dabigatran etexilate (hereafter referred to as dabigatran) and rivaroxaban, have been approved in more than 70 countries for prevention of venous thromboembolism after elective hip or knee arthroplasty. Dabigatran targets thrombin (factor IIa) and rivaroxaban targets factor Xa1 (figure⇓).
A 78 year old woman has had an elective left hip arthroplasty and on discharge her orthopaedic surgeon prescribes a further, 28 day postoperative course of anticoagulant prophylaxis. She sees her general practitioner a week later, concerned that these “blood thinners” are tablets, whereas she had daily injections after her knee replacement three years ago. Her general practitioner explains that the tablets have recently become available and that guidelines recommend them as an alternative to injections as they are as effective, more convenient, and safe.
Evidence based guidelines recommend anticoagulant thromboprophylaxis with subcutaneous agents such as low molecular weight heparin or fondaparinux or oral agents such as warfarin, dabigatran, or rivaroxaban for at least 10 days after knee arthroplasty and for up to 35 days after …