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Venous thromboembolic (VTE) events are a major concern in large joints replacement leading to patients’ death. The prevention of VTE events suggests the prescription of low molecular weight heparin or oral anticoagulants that differ significantly in their efficacy, safety and cost of the therapy.

Aim. To assess the cost-effectiveness of different options for the prevention of VTE events in hip and knee joints replacement.

Material and methods. The model, which allows evaluation of the VTE complications incidence in patients aged 60-65years, was developed based on the results of such clinical trials as ADVANCE-2, ADVANCE-3, RE-MODEL, RE-NOVATE. Analysis was performed on survival period of patients. Weighted average prices of public bidding for the purchase of drugs (enoxaparin, dabigatran and apixaban) during the first quarter of 2015 were the source of the data on the expenses on VTE events prevention. The cost of treatment of VTE events matched for the rate of compulsory health insurance in St. Petersburg for 2015. The costs and life expectancy of patients were discounted at 3.5% per year.

Results. The best results for the prevention of VTE events are observed at the treatment regimen with apixsaban. Treatment regimens with dabigatran and enoxaparin were less effective and comparable with each other. At that, the prevalence of major bleedings was similar for all treatment regiments. Apixaban reduced the cost of treatment and prevention of VTE events 1.8-2.0 times as compared with enoxaparin and 1.2-1.4 times in comparison with dabigatran.

Conclusion. The new oral anticoagulants are effective and safe alternative to low molecular weight heparins used for the prevention of VTE events in large joints replacement and provide budgetary savings as compared with enoxaparin. Apixaban has a maximum capacity for the reduction of VTE events, lowering the cost of treatment and prevention of VTE events.

About the Author

A. V. Rudakova
St. Petersburg State Chemical Pharmaceutical Academy
Russian Federation
Professora Popova ul. 14, St. Petersburg, 197376 Russia


1. Russian clinical recommendations for diagnosis, treatment and prevention of venous thromboembolic complications. Flebologiya 2010; 4 (1) Issue 2: 1-37. Russian (Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений. Флебология 2010; 4 (1) вып. 2: 1-37).

2. Lassen M.R., Raskob G.E., Gallus A., et al. Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. Lancet 2010; 375 (9717): 807-15.

3. Lassen M.R., Gallus A., Raskob G.E., et al. Apixaban versus enoxaparin for thromboprophylaxis after hip replacement. N Engl J Med 2010; 363 (26): 2487-98.

4. Eriksson B.I., Dahl O.E., Rosencher N., et al. Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: a randomised, double-blind, non-inferiority trial. Lancet 2007; 370 (9591): 949-56.

5. Eriksson B.I., Dahl O.E., Rosencher N., et al. Oral dabigatran etexilate vs. subcutaneous enoxaparin for the prevention of venous thromboembolism after total knee replacement: the RE-MODEL randomized trial. J Thromb Haemost 2007; 5 (11): 2178-85.

6. Riemsma R., Joore M., Grutters J., et al. Apixaban for the prevention of venous thromboembolism in people undergoing elective knee and hip replacement surgery: a Single Technology Appraisal. York: Kleijnen Systematic Reviews Ltd.; 2011.

7. Prandoni P., Lensing A.W., Cogo A., et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996; 125 (1): 1-7.

8. Imperiale T.F., Speroff T. A meta-analysis of methods to prevent venous thromboembolism following total hip replacement. JAMA 1994; 271 (22): 1780-5.

9. Janet AK, Voskanyan YE. Evaluating the effectiveness of the integrated prevention of venous thromboembolic complications in hospitalized patients. Kubanskiy Nauchnyy Meditsinskiy Vestnik 2010; 9: 191-7. Russian (Жане А.К., Восканян Ю.Э. Оценка эффективности комплексной профилактики венозных тромбоэмболических осложнений у госпитальных больных. Кубанский Научный Медицинский Вестник 2010; 9: 191-7).

10. NICE Clinical Guideline 92 (2010): reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital Available at: Accessed by 15.06.2015.

11. Sulimov VA Belentsov SM, NI Golovin et al. Prevalence and prevention of thromboembolic events in clinical practice: results of the Russian international register ENDORSE. Klinicheskaya Farmakologiya i Terapiya 2008;17(3):32-40. Russian (Сулимов В.А., Беленцов С.М., Головина Н.И. и др. Распространенность и профилактика тромбоэмболий в клинической практике: российские результаты международного регистра ENDORSE. Клиническая Фармакология и Терапия 2008;17(3):32-40).

12. Nieto J.A., Espada N.G., Merino R.G., Gonzalez T.C. Dabigatran, rivaroxaban and apixaban versus enoxaparin for thomboprophylaxis after total knee or hip arthroplasty: pool-analysis of phase III randomized clinical trials. Thromb Res 2012; 130 (2): 183-91.

13. Cohen A., Drost P., Marchant N., et al. The efficacy and safety of pharmacological prophylaxis of venous thromboembolism following elective knee or hip replacement. Systematic review and network meta-Analysis. Clinical and Applied Thrombosis/Hemostasis 2012; 18: 611-27.

14. Pebanco G.D., Kaiser S., Haines S. Anticoagulation; New Pharmacologic Methods to Prevent Venous Thromboembolism in Older Adults: A Meta-Analysis. Annals of Pharmacotherapy 2013;47:605-16.

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