title: Oral thromboprophylaxis following total hip replacement: the issue of compliance.
abstract: BACKGROUND
  Thirty-five to 40 days' thromboprophylaxis is recommended following total hip replacement (THR). Low molecular weight heparin (LMWH) injected by a health professional ensures good compliance. Compliance with recent oral anticoagulants has not been precisely assessed. Oral self-administration, without coagulation monitoring tests, may be a worrying issue in the management of what is a potentially catastrophic adverse event, without prodromal symptoms alerting the patient to the need for regular intake throughout the prescription period.
  
  
  OBJECTIVE
  It was hypothesized that compliance with these new oral anticoagulants is good over the entire treatment period.
  
  
  METHODS
  The present cohort study prospectively assessed compliance with oral medication (two capsules of dabigatran etexilate [Pradaxa(®)] per day in a single dose at a set time) following THR. An electronic device continuously monitored the day and time of extraction of capsules from the package. All included patients underwent clinical and echo-Doppler examination at day 30±5 after the start of the study.
  
  
  RESULTS
  Fifty-six patients were included at their discharge home. Overall compliance was 98.1% (3,188/3246 capsules correctly taken), falling off slightly over time but never below 97.1%. One patient was diagnosed with symptomatic thrombophlebitis 34 days postoperatively, associated with non-compliance at day 11. End of follow-up echo-Doppler found four cases of asymptomatic distal venous thrombosis. There were no hemorrhagic complications.
  
  
  CONCLUSIONS
  The risk of thromboembolic complications diminishes over time, while oral anticoagulants have a wide therapeutic window and relatively long half-life (15-17 hrs). Efficacy was demonstrated, with improved patient comfort and cost-saving. Compliance in the present series was satisfactory. This, however, should not mean that patients not be appropriately informed, as in the present study, so as to improve compliance.
  
  
  METHODS
  Level III, prospective diagnostic.
authors.affiliation: Caen University Hospital Center, Orthopedics Department, Avenue de la Côte-de-Nacre, 14000 Caen, France.
authors.forename: B
authors.initials: B
authors.lastname: Lebel
authors.forename: M
authors.initials: M
authors.lastname: Malherbe
authors.forename: S
authors.initials: S
authors.lastname: Gouzy
authors.forename: J-J
authors.initials: JJ
authors.lastname: Parienti
authors.forename: J-J
authors.initials: JJ
authors.lastname: Dutheil
authors.forename: M-T
authors.initials: MT
authors.lastname: Barrellier
authors.forename: C
authors.initials: C
authors.lastname: Vielpeau
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D058833:Antithrombin Proteins; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001562:Benzimidazoles / Q000008:administration & dosage*; D000069604:Dabigatran; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006801:Humans; D055118:Medication Adherence; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D011725:Pyridines / Q000008:administration & dosage*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D058833:Antithrombin Proteins; D001562:Benzimidazoles; D011725:Pyridines; D000069604:Dabigatran