The parenteral anticoagulant enoxaparin, a low-molecular-weight heparin, is widely used for prophylaxis of venous thromboembolism (VTE) following total hip replacement. New evidence indicates that a novel oral direct thrombin inhibitor, dabigatran etexilate (DE), is equally effective.

In a study involving 3,494 patients undergoing total hip replacement, researchers randomized patients to receive either 28 to 35 days of DE or subcutaneous injections of enoxaparin. Of those taking DE, about half took 220 mg and half took 150 mg once daily, starting with a half-dose 1 to 4 hours after surgery. Those receiving injections received 40 mg of enoxaparin once daily starting the evening before surgery.

Death from all causes, including VTE, occurred in 6% of patients taking 220 mg of DE, in 8.6% of patients taking 150 mg of DE, and in 6.7% of patients receiving enoxaparin. No significant differences existed between the three treatment groups in rates of VTE, bleeding, frequency of coronary events, or increased liver enzymes.

Source: Eriksson BI, et al., Dabigatran etexilate versus enoxaparin for prevention of venous thromboembolism after total hip replacement: A randomised, double-blind, non-inferiority trial, The Lancet, September 15, 2007.