Changing Patterns of Anticoagulation After Total Hip Arthroplasty in the United States: Frequency of Deep Vein Thrombosis, Pulmonary Embolism, and Complications With Rivaroxaban and Warfarin
| Autor: | Paul F. Lachiewicz, Mrudula B. Glassberg |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Databases Factual Deep vein Arthroplasty Replacement Hip Hemorrhage Medicare 03 medical and health sciences 0302 clinical medicine Rivaroxaban Internal medicine medicine Odds Ratio Humans Orthopedics and Sports Medicine Adverse effect Aged Retrospective Studies Venous Thrombosis 030222 orthopedics business.industry Warfarin Anticoagulants Odds ratio Health Services Middle Aged medicine.disease Thrombosis Confidence interval United States Pulmonary embolism medicine.anatomical_structure Female business Pulmonary Embolism medicine.drug |
| Zdroj: | The Journal of arthroplasty. 34(8) |
| ISSN: | 1532-8406 |
| Popis: | Background This study evaluated the trends in anticoagulation use after total hip arthroplasty (THA), and the effectiveness and safety of rivaroxaban compared to warfarin. Methods This retrospective database analysis used healthcare claims from the Truven Health MarketScan database (2010-2015). Patients undergoing elective THA were followed for use of anticoagulants after surgery. Logistic regression models were used to compare differences in deep vein thrombosis (DVT), pulmonary embolism (PE), and adverse events, within 90 days after THA, among warfarin and rivaroxaban users. Inverse probability treatment weighting was used to account for selection bias. Results There were 12,876 users of warfarin and 10,892 users of rivaroxaban in commercially insured (CI) patients, and 7416 warfarin users and 4739 rivaroxaban users in Medicare supplement (MS) patients. Warfarin use decreased over time in both insurance cohorts, whereas rivaroxaban use increased from 2011 to 2015. Warfarin users were significantly more likely to experience both DVT (CI: odds ratio [OR] 2.63, 95% confidence interval 1.97-3.50; MS: OR 1.78, 95% confidence interval 1.38-2.29) and PE (CI: OR 2.60, 95% confidence interval 2.04-3.31; MS: OR 2.09, 95% confidence interval 1.66-2.65). There was no significant difference in rates of bleeding between the 2 agents, but warfarin users had higher odds of periprosthetic joint infection in both cohorts (CI: OR 1.57, 95% confidence interval 1.16-2.13; MS: OR 1.79, 95% confidence interval 1.14-2.81). Conclusion There has been an increase in prophylaxis with rivaroxaban, and a decrease in warfarin use after elective THA over 4 years. Warfarin users were more likely to experience DVT and PE than rivaroxaban, and bleeding risks were similar. |
| Databáze: | OpenAIRE |
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