| Summary: | 碩士 === 高雄醫學大學 === 藥學研究所 === 102 === Objectives: Total hip replacement (THR) or total knee replacement (TKR) usually accompanies Venous thromboembolism (VTE). The inci-dence of VTE could be reduced but bleeding increased if preventive an-tithrombotic medicine was used for total joint replacement. Based on the data provided by the Department of National Heath in Taiwan, this study was designed to investigate the prophylactic approach with anticoagula-tion agents, including rivaroxaban prescribed to prevent the occurrence of DVT after THR or TKR by the orthopedic surgeon in Taiwan.
Methods: This was a retrospective study of analyses on the data be-tween 2007 and 2013. The analyses were divided into two parts: (1) part I: the antithrombotic drugs prescribed by orthopedic surgeons for the pre-vention of DVT or PE after total joint replacement (including THR, TKR, revision for THR or TKR, partial joint replacement etc) between 2007 and 2011, based on the data provided by the National Health Insurance Administration (NHIA); and (2) part II: the prescription of rivaroxaban based on the same provided data in 2012.
Results: Comparing the data between those obtained in 2007~2011 (part I) and in 2012 (part II), there was a tendency that the cost, amount of prescriptions, and number of cases received prescriptions, were in-creased in all 3 categories of medical facilities: medical centers, regional hospitals, and area hospitals. Further analysis indicated that the costs for the use of anticoagulation drugs (including Vitamin K antagonist and heparins) were reduced later. The amount of prescriptions and the total cases with prescriptions were reduced remarkably.
From 2007~2011, there were no significant changes in the number of cases with total joint replacement; about 37 % of cases were performed in the medical centers or regional hospitals, and 26 % of cases in the area hospitals. Among them, 45% were performed in the north district, 34% in the south district, 18% in the middle district, and 3% in the east district. However, the total cost and the total amount of antithrombotic prescrip-tions, and total cases with antithrombotic prescriptions were increased progressively the highest cost was that for the prescription of heparins. Comparing the patients with DVT received antithrombotic agents therapy (n = 310) to the patients received total joint replacement treated with prophylactic antithrombotic agents (n = 13600), the occurrence of DVT was significantly reduced (p=0.044). The prescription of the new antico-agulation drug, rivaroxaban, reduced the incidence of venous thrombo-embolism significantly after THR and TKR and also reduced the dates of hospitalization significantly. However, there was no significant difference in the occurrence of bleeding comparing to those treated with other an-tithrombotic agents.
Conclusions: The cases of thromboembolic complications after total joint replacements have been reduced gradually since the prescriptions of prophylactic antithrombotic drugs have been increased progressively. The prescription of the oral anticoagulation drug, rivaroxaban, reduced the in-cidence of venous thromboembolism after THR and TKR, but with equal incidence of bleeding and expenditures comparing to those treated with other antithrombotic agents. However, in future, further clinical studies of rivaroxaban in preventing the incidence of venous thrombolism are re-quired in order to confirm the cost-effective principle of National Health Insurance.
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