Abstract
Aims
NICE recommends oral anticoagulants after lower limb arthroplasty, as they are thought to lead to better outpatient compliance than injected anticoagulants. Having prescribed self-administered Dalteparin for many years, we began using oral Dabigatran in December 2010. The change afforded an opportunity to compare compliance and acceptability of the two treatments.
Methods
Patients were recruited at discharge and telephoned at 28 days. Left over doses were counted to assess compliance. Side-effects, complications and patient views were also recorded.
Results
47 patients were discharged on dalteparin, 59 on dabigatran. Total compliance rates were 81% and 56% respectively (p<0.001). However, the mean pain score associated with dalteparin was 2.4 out of 10, and 31% of patients experienced significant bruising. No patient suffered pain or bruising with dabigatran (p<0.001), but two experienced dyspepsia and four suffered wound problems. Two thromboembolic events and one gastrointestinal bleed occurred in the dalteparin group.
Conclusions
Our outpatient compliance is higher for injected anticoagulants than for oral anticoagulants. This runs contrary to some of the marketing for oral agents. However, Dabigatran offers better patient acceptability than Dalteparin. While not designed or powered to show statistically significant differences in complication rates, our study has prompted closer investigation of wound problems with both treatments.
