title: [Dabigatran etexilate use among older adults in a home-care system after hip or knee replacement surgery].
abstract: BACKGROUND
  Hip replacement surgery (HRS) and knee replacement surgery (KRS) require long-term deep venous thrombosis (DVT) prophylaxis. This study describes dabigatran etexilate (DE) use in post-surgical older adults who underwent HRS and KRS in a clinical practice setting in a home-care system.
  
  
  METHODS
  A retrospective descriptive cohort study included elective HRS and KRS postsurgical older adults under home care receiving either DE (n=76) or enoxaparin (n=80). DE was indicated by using the same selection criteria and dosing as in the RE-MODEL and RE-NOVATE studies. The enoxaparin 40 mg/day patients were included as historic controls when they met the same selection criteria as DE patients. Symptomatic DVT, bleeding rate, re-admission rate and mortality during the 90-day postsurgical period were analyzed.
  
  
  RESULTS
  The mean age of the DE group was 74 (5) years old, with 74% females. There were no significant differences in age, gender and type of replacement between the two groups. There were four DVT in each group (50% proximal), with no significant differences found between groups. There was one pulmonary thromboembolism in the DE group, and one major bleeding in the enoxaparin group. There were no deaths during the 90-day follow-up; however, two re-hospitalizations occurred in the DE group. The details on introducing DE use in our home-care system are also described.
  
  
  CONCLUSIONS
  In appropriately selected older adults DE seems to be an effective choice for DVT prophylaxis in home-care in a clinical practice setting.
authors.affiliation: Sección Medicina Domiciliaria, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. javier.saimovici@hiba.org.ar
authors.forename: Javier Matías
authors.initials: JM
authors.lastname: Saimovici
authors.forename: Ricardo Ángel
authors.initials: RÁ
authors.lastname: La Valle
authors.forename: Sergio
authors.initials: S
authors.lastname: Zunino
authors.forename: Martín
authors.initials: M
authors.lastname: Silveira
authors.forename: Gabriel Darío
authors.initials: GD
authors.lastname: Waisman
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D058833:Antithrombin Proteins / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001562:Benzimidazoles / Q000627:therapeutic use*; D015331:Cohort Studies; D000069604:Dabigatran; D017984:Enoxaparin / Q000627:therapeutic use*; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D011725:Pyridines / Q000627:therapeutic use*; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D058833:Antithrombin Proteins; D001562:Benzimidazoles; D017984:Enoxaparin; D011725:Pyridines; D000069604:Dabigatran