title: Thromboprophylaxis in patients older than 75 years or with moderate renal impairment undergoing knee or hip replacement surgery [corrected].
abstract: OBJECTIVE
  Prospective, double-blind studies in orthopaedic patients have been conducted using the direct thrombin inhibitor dabigatran etexilate (hereafter referred to as dabigatran), with two doses investigated and approved for adults (220 mg and 150 mg once daily) to prevent venous thromboembolism (VTE). The European Medicines Agency decided that in major joint orthopaedic surgery, the lower dose should be used in elderly patients (aged over 75 years) and those with reduced renal function (creatinine clearance between 30 and 50 ml/min). Our objective was to understand the efficacy and bleeding data for the lower dose in this subpopulation.
  
  
  METHODS
  We extracted and analysed data from the elderly or from moderately renally impaired patients (n 632 of = 5,539) from the orthopaedic clinical development programme of dabigatran.
  
  
  RESULTS
  Dabigatran 150 mg once daily was as effective as the standard European enoxaparin regimen, with numerically fewer major bleeding events. Rates of major VTE were 4.3% vs 6.4% of patients, respectively. Major bleeding events occurred in four (1.3%) vs 11 (3.3%), which shows a trend towards lower bleeding with dabigatran 150 mg [odds ratio (OR) 0.40; 95% confidence interval (CI) 0.13-1.25; p = 0.110]. Mean volume of blood loss was 395 vs 417 ml, and transfused units were 2.4 vs 2.5, respectively. Other safety parameters, including the incidence of wound infections and complications, were similar for 150 mg once daily dabigatran and enoxaparin.
  
  
  CONCLUSIONS
  For patients at higher risk of bleeding, dabigatran 150 mg once daily is as effective as enoxaparin following major orthopaedic surgery and is associated with a favourable bleeding rate.
authors.affiliation: Department of Orthopaedics, Elverum Central Hospital, Kirkevn 7, 2418 Elverum, Norway. oladahl@start.no
authors.forename: Ola E
authors.initials: OE
authors.lastname: Dahl
authors.forename: Andreas A
authors.initials: AA
authors.lastname: Kurth
authors.forename: Nadia
authors.initials: N
authors.lastname: Rosencher
authors.forename: Herbert
authors.initials: H
authors.lastname: Noack
authors.forename: Andreas
authors.initials: A
authors.lastname: Clemens
authors.forename: Bengt I
authors.initials: BI
authors.lastname: Eriksson
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D001562:Benzimidazoles / Q000627:therapeutic use*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D000069604:Dabigatran; D004311:Double-Blind Method; D017984:Enoxaparin / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D001562:Benzimidazoles; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D015091:beta-Alanine; D000069604:Dabigatran
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