The use of Dabigatran Etexilate for primary thromboprophylaxis after hip replacement

Introduction: The risk of thromboembolic events for patients who have undergone a total hip arthroplasty is about of 45–70 % without a prophylaxis, for this reason a specific thromboprophylaxis is recommended. The use of low-molecular-weight heparins is often characterized by a poor compliance with reference to a subcutaneous administration. The dabigatran etexilate is a direct thrombin inhibitor administered by mouth. The objective of this research is to test a selected population of patients subjected to a primary prophylaxis by Dabigatran Etexilate after total hip arthroplasty. Materials and methods: Since November 2010 to December 2011 we carried out a primary thromboembolic prophylaxis by Dabigatran Etexilate with 80 patients who underwent a first total hip arthroplasty. We underwent a retrospective analysis evaluating all the medical records, the outpatient controls after 1–3 months from the operation and a final phone interview. We left off the patients with a moderate or heavy kidney insufficiency, liver insufficiency, coagulation alter-ations, uncontrolled hypertension, acute ischemic stroke in the previous 6 months, cases of hemorrhagic stroke in the previous 6 months, gastrointestinal or urogenital bleedings. We also excluded patients subjected to a therapy with oral anticoagulants, antiaggregants (except ASA). The dosage was of 220 mg daily for patients under 75 and 150 mg daily for patients over 75, prophylaxis was continuated for 35 days. Collected data: length of the operation, blood loss, haemocrome pre-op. and V gg post-op., surgical drain, blood transfusion, length of the immobilization, post-surgical haematomas, symptomatic Deep Vein Thrombosis appearance, PE major-minor bleedings, adverse events, satisfaction, compliance. Results No events of PE, of mortality correlated to thromboembolic events, one case of Deep Vein Thrombosis, two cases of major bleeding, no major adverse reactions. All the patients, except the patients with DVT, completed the therapy. Discussion: The Dabigatran Etexilate has shown its efficacy and safety, not lower than what we learn in literature, for the LMWHs. The compliance and satisfaction for the oral therapy have been higher than what is reported in literature as to a subcutaneous consumption of LMWHs. Conclusions: By a retrospective analysis of the selected patients the Dabigatran Etexilate will be an effective alternative to the use of LMWHs for both its efficacy and safety. The examined patients have shown a higher compliance and pleasure for the oral therapy as to a hypothetical subcutaneous one.