Patient compliance with new oral anticoagulants after major orthopaedic surgery: rivaroxaban and dabigatran compared with subcutaneous injection of fondaparinux

Abstract

Purpose: the main purpose of our study was to compare patient compliance with the orally administered new oral anticoagulants (noCs) dabigatran and rivaroxaban compared with subcutaneously injected fondaparinux after major orthopaedic surgery, and to assess patient preference for the oral vs subcutaneous administration route. Methods: prophylactic antithrombotic drug therapy with dabigatran (group D; GD, n=32 patients), rivaroxaban (group R; GR, n=38 patients) or fondaparinux (group F; GF, n=30 patients), to prevent deep vein thrombosis, was started immediately after surgery in 100 patients submitted to total hip arthroplasty. Results: the patients had a mean age of 68.7±11 years and 62% were female. in GD, 87.5% of patients indicated that they preferred oral intake of medications to subcutaneous injection (12.5%). in GR, 84.2% declared a preference for oral administration over subcutaneous injection (15.8%). in GF, a surprisingly high proportion of patients (73.3%; p < 0.001) declared that they preferred subcutaneous administration of medications over the oral route (26.7%). overall, the rate of compliance with antithrombotic drug therapy was very high, at 99%. Conclusions: intake of the noAs dabigatran and rivaroxaban following hospital discharge is entirely the responsibility of the patient; a high level of patient compliance with these drugs must therefore be demonstrated in order for them to become well accepted within the medical community. the results of this study showed a very high level of compliance both with orally and subcutaneously administered drugs. Level of evidence: Level i, randomized clinical study.

Aspirin: are patients actually taking it?—A quality assessment study

“…Many factors contribute to patient adherence to medications including convenience, cost, dosing regimen, side effects, and patient education. In comparison to traditional VTE prophylaxis regimens that may require frequent injections and laboratory monitoring, aspirin is administered orally and may be preferred by some patients [15] . The cost of aspirin is also less than other traditional VTE prophylaxis agents such as warfarin, dabigatran, and rivaroxaban.…”

“…A third and fourth dose per day decreased adherence further to 65% and 51%, respectively. Other studies reported greater than 90% adherence to VTE prophylaxis after a THA, using a once-daily dosing regimen [15] , [17] .…”

Post‐discharge patient‐reported non‐adherence to aspirin compared to enoxaparin for venous thromboembolism prophylaxis after hip or knee arthroplasty

“…5 A second study (n = 130) reported very high adherence rates, with 97% (n = 38) adherent to rivaroxaban, 100% (n = 32) to dabigatran (oral) and 100% (n = 30) to fondaparinux (injection). 11 The lack of consistent results across each of the studies above and our study may be due to the heterogeneity of adherence questionnaires used, heterogeneity in indication for surgery and demographics across study populations (trauma and arthroplasty) as well as suboptimal power due to the relatively small sample sizes. Further evidence is required to investigate the hypothesis that adherence to enoxaparin is lower than aspirin after hospital discharge following THA or TKA, given enoxaparin's greater effectiveness in preventing symptomatic 90-day VTE.…”

“…There have been two studies comparing adherence rates for aspirin to LMWH following orthopaedic trauma 9,10 and two studies comparing adherence for DOACs (oral prophylaxis) to LMWH following THA and TKA. 5,11 Like this study, each hypothesised greater adherence with oral compared to injectable medications, due to their greater ease of administration. The first study in orthopaedic trauma patients (n = 150) reported non-adherence of 29% with aspirin (81 mg BD orally) and 41% with LMWH (30 mg BD, subcutaneously) while the second (n = 61) reported non-adherence of 37% with aspirin (75 mg, frequency not provided) and 19% with LMWH (dose and frequency not provided).…”

“…Previously published studies have either compared twice-daily aspirin to LMWH for orthopaedic trauma patients 9,10 or DOACs to LMWH following THA or TKA. 5,11 The reasons underlying non-adherence have also been poorly reported, with the exception of one study which found that the most common reasons for non-adherence to extended aspirin prophylaxis were a lack of patient belief that it was required for 6 weeks, uncertainty regarding the required prophylaxis duration and conflicting advice given by practitioners other than the treating surgeon. 12 The CRISTAL trial 13 aimed to determine if aspirin was noninferior to enoxaparin in preventing symptomatic VTE within 90 days following THA or TKA.…”